case study on climate change pdf

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• Published: 19 March 2019

Climate change adaptation in South Africa: a case study on the role of the health sector

• Matthew F. Chersich   ORCID: orcid.org/0000-0002-4320-9168 1 &
• Caradee Y. Wright 2  

Globalization and Health volume  15 , Article number:  22 ( 2019 ) Cite this article

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Globally, the response to climate change is gradually gaining momentum as the impacts of climate change unfold. In South Africa, it is increasingly apparent that delays in responding to climate change over the past decades have jeopardized human life and livelihoods. While slow progress with mitigation, especially in the energy sector, has garnered much attention, focus is now shifting to developing plans and systems to adapt to the impacts of climate change.

We applied systematic review methods to assess progress with climate change adaptation in the health sector in South Africa. This case study provides useful lessons which could be applied in other countries in the African region, or globally. We reviewed the literature indexed in PubMed and Web of Science, together with relevant grey literature. We included articles describing adaptation interventions to reduce the impact of climate change on health in South Africa. All study designs were eligible. Data from included articles and grey literature were summed thematically.

Of the 820 publications screened, 21 were included, together with an additional xx papers. Very few studies presented findings of an intervention or used high-quality research designs. Several policy frameworks for climate change have been developed at national and local government levels. These, however, pay little attention to health concerns and the specific needs of vulnerable groups. Systems for forecasting extreme weather, and tracking malaria and other infections appear well established. Yet, there is little evidence about the country’s preparedness for extreme weather events, or the ability of the already strained health system to respond to these events. Seemingly, few adaptation measures have taken place in occupational and other settings. To date, little attention has been given to climate change in training curricula for health workers.

Conclusions

Overall, the volume and quality of research is disappointing, and disproportionate to the threat posed by climate change in South Africa. This is surprising given that the requisite expertise for policy advocacy, identifying effective interventions and implementing systems-based approaches rests within the health sector. More effective use of data, a traditional strength of health professionals, could support adaptation and promote accountability of the state. With increased health-sector leadership, climate change could be reframed as predominately a health issue, one necessitating an urgent, adequately-resourced response. Such a shift in South Africa, but also beyond the country, may play a key role in accelerating climate change adaptation and mitigation.

The impacts of global changes in climate are rapidly escalating in South Africa. Unless concerted action is taken to reduce greenhouse gas emissions, temperatures may rise by more than 4 °C over the southern African interior by 2100, and by more than 6 °C over the western, central and northern parts of South Africa [ 1 , 2 ]. Extreme weather events are the most noticeable effects to date, especially the drought in the Western Cape and wildfires, but rises in vector- and waterborne diseases are also gaining prominence. Global warming, which manifests as climate variability, has already been implicated in increased transmission of malaria, Rift Valley Fever, schistosomiasis, cholera and other diarrheal pathogens, and Avian influenza in the country [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Studies have documented the considerable impact of high ambient temperatures on mortality in the country, with mortality rises of 0.9% per 1 °C above certain thresholds, and considerably higher levels in the elderly and young children [ 11 , 12 ]. Food security is under threat, with, for example, crop yields likely to decline in several provinces, with concomitant loss of livestock [ 13 ]. Moreover, any negative impacts of climate change on the country’s economy will have major implications for people’s access to food, which is largely contingent on affordability. Food access is already tenuous given the existing levels of poverty and as ownership of arable land is highly inequitable, reflecting the particular history of the country [ 14 ].

The impact of rises in temperature are especially marked in occupational settings, particularly in the mining, agriculture and outdoor service sectors [ 15 , 16 , 17 ]. Impacts, including measurable mortality effects, are heightened in those living in informal settlements, where houses are often constructed of sheets of corrugated iron [ 18 , 19 , 20 ]. In addition, heat increments are pronounced in many schools and health facilities as these have not been constructed to withstand current and future temperature levels [ 21 , 22 ]. Importantly, all the impacts of climate change affect mental health, in a nation where already one sixth of the population have a mental health disorder [ 23 ].

While climate mitigation efforts, especially a reduction in carbon-based power production, have garnered much attention, focus is shifting to more direct, and shorter or ‘near’ term actions to counter the impacts of climate change [ 24 , 25 , 26 ]. These actions – commonly called adaptation measures – range from building the resilience of the population and health system, to preparing for health impacts of extreme weather events and to reducing the effects of incremental rises in heat in the workplace and other settings [ 27 ].

Most importantly, the effectiveness of adaptation pivots on reducing levels of poverty and inequities, especially in women and other vulnerable groups. Simply put: if an individual’s or household’s socio-economic status is robust, they will have a greater ability to withstand shocks induced by climate change. In South Africa, however, about a quarter of the population are unemployed and over half live below the poverty line [ 28 ]. Poverty reduction initiatives, such as the highly successful social grants system [ 29 ], thus lie at the heart of health adaptation. These initiatives already reach 17.5 million vulnerable people in South Africa [ 30 ], could be further extended to counter balance the disproportionate effects of climate change on vulnerable groups [ 31 ]. Equally, having a resilient health system is central to effective climate change adaptation.

While health professionals can play a critical role in advocating for stronger mitigation efforts such as a shift from brown to green energy (the government envisages that in 2030, still two thirds of energy production in the country will be coal-based [ 32 ]), the contribution of the health sector mostly centres around climate change adaptation. Several features of an effective health-sector adaptation response bear mention [ 33 ]. Firstly, national- and local-level policy frameworks and plans are required, supported by adequate resources. In particular, emergency incident response plans are needed for events such as heat waves, wildfires, floods, extreme water scarcity and infectious disease outbreaks [ 34 ]. These response plans set out the procedures to follow in the case of such events and the responsibilities of different actors. Secondly, communication is a key component of adaptation strategies, targeting a wide range of audiences, and using social and other media. Long-term communications strategies, such as “Heat education” campaigns, can raise awareness of the health risks of heat waves, and help prepare individuals and communities to self-manage their responses to increased heat [ 35 ]. Then, more short-term response communication is needed when an actual extreme weather event is forecast, making the public aware of an impending period of risk and what steps are needed to ameliorate that risk. Thirdly, the effectiveness of adaptation interventions rests on the strength of data systems and surveillance. Aside from providing warnings of extreme weather events, heightened surveillance is required of diseases associated with environmental factors, together with concerted efforts to systematically document the effectiveness of adaptation responses and to identify opportunities for improving services.

There is clearly a real opportunity to bring the credible voice and considerable resources of the health sector to bear on climate change policies and programmes [ 36 , 37 , 38 ]. It is important to assess the extent to which this is occurring and gaps in this response. Some reviews have examined this issue in South Africa [ 39 , 40 , 41 ], but none have done so recently, or employed systematic review methodology. This study fills that gap and presents lessons from the response in South Africa that might be applied in other countries and, indeed, globally [ 42 ]. In recent decades, South Africa has played a leading role in tackling public health issues affecting the African region, especially in the HIV field. The country has the potential, drawing on its research and programme expertise, to play a similar role in climate change adaptation, galvanising action in other parts of the continent. Thus, while the impacts of climate are somewhat unique to each country and even within different parts of a country, lessons drawn from this case study may provide useful insights for other countries in the region.

The paper is divided into two thematic areas. The first covers policy frameworks relating to climate change adaptation, as well as data monitoring and surveillance of climate change adaptation in the country. The second reviews the level of preparedness and actions already taken for extreme weather events, rises in temperature and infectious disease outbreaks. Topics indirectly related to health, such as food security, are not addressed in the paper, though remain of key importance.

Review methods

We systematically reviewed literature indexed in PubMed (Medline) and Web of Science for articles that address climate change adaptation in South Africa. Full details and the PRISMA Flow Chart are described elsewhere [ 43 ]. The Pubmed search strategy included free text terms and controlled vocabulary terms (MeSH codes), specifically: (((((“South Africa”[MeSH]) OR (“South Africa”[Title/Abstract]) OR (“Southern Africa*”[Title/Abstract]))) AND “last 10 years”[PDat])) AND (((“global warming”[Title/Abstract] OR “global warming”[MeSH] OR climatic*[Title/Abstract] OR “climate change”[Title/Abstract] OR “climate change”[MeSH] OR “Desert Climate”[MeSH] OR “El Nino-Southern Oscillation”[MeSH] OR Microclimate[MeSH] OR “Tropical Climate”[MeSH])). This strategy was translated into a Web of Science search.

In total, 820 titles and abstracts were screened by a single reviewer after removal of 34 duplicate items. To be included, articles had to describe adaptation interventions to reduce the impact of climate change on health in South Africa. All study designs were eligible and no time limits were imposed. We excluded articles that were not in English ( n  = 3), only covered animals or plants ( n  = 345), were not on South Africa ( n  = 273), were unrelated to health ( n  = 57) or to climate change ( n  = 56), or were only on climate change impact ( n  = 34) or mitigation ( n  = 31). In total, we screened 86 full text articles for eligibility, 21 of which were included (Fig.  1 ). We also included literature located through searches of article references (one additional paper) or through targeted internet searches. Thereafter, we extracted data on the characteristics of the included articles, including their study design and outcome measures (Table  1 ). In analysis, we grouped studies on similar topics and, where possible, attempted to highlight commonalities or differences between the study findings. Policy documents were located by searching the website of the National Department of Environmental Affairs ( https://www.environment.gov.za ) and the National Department of Health ( http://www.health.gov.za/ ), and by asking experts familiar with these policies in South Africa.

PRISMA Flow Diagram for Review of health-related adaptation to Climate Change in South Africa

Engagement of the health sector in climate change policies, planning and data systems

We located 14 journal articles on health sector engagement. With these limited number of records, results are presented as a narrative, rather than as a comparison of findings in different parts of the country or across population groups. We first discuss national and local policies and practices, and then turn to assess the climate and health monitoring systems in the country.

In recent years, the national government has developed a series of documents covering key legislative and strategic aspects of adaptation. In 2018, the government released a draft of the National Climate Change Response White Paper which sets out the different ways in which climate change considerations can be integrated within all sectors, including health. This document updates the 2011 White Paper on this topic. More recently, the draft National Climate Change Bill was made available for comment [ 24 ]. Little reference is made to human health and scanty detail is provided on actual implementation of the policies. Additionally, in 2017, the second draft of the South African National Adaptation Strategy was made open for public comment [ 25 ]. This is a ten-year plan, which describes key strategic areas, with measurable outcomes. The strategy acts as a reference point for all climate change adaptation efforts in South Africa, providing overarching guidance across the various sectors of the economy. As such, it seeks to ensure that different levels of government and the private sector integrate and reflect climate change adaptation. The implementation priorities for health are listed as water and sanitation, early warning systems for effective public health interventions during extreme weather events, and occupational health.

While national policies set the stage for lower levels of government and funding prioritisation, much of the actual planning for climate change adaptation occurs at the provincial and local government level. Most importantly, each local area government is charged with developing an Integrated Development Plan every five years, involving many sectors, including health [ 44 ]. Health implications of climate change are mentioned in some of these plans, but not all [ 45 , 46 , 47 ]. A survey of Environmental Health Practitioners ( n  = 48), who are at the forefront of implementing these plans, provides insights of the degree to which climate change priorities have been incorporated within these plans [ 48 ]. Though almost all felt that they should play a supportive or leading role in addressing climate change, only half had a budget allocated for climate change and health-related work, and only a third had ever participated in climate change-related projects. Another study involving fieldwork in a range of settings in South Africa reported that, for climate change adaptation plans to be successful, local communities need to be more involved in their design and implementation [ 49 ]. A further study in eThekwini Municipality, KwaZulu-Natal Province noted that few climate change advocates had emerged among local politicians and civil servants, and that decisions made at the local government level seldom took climate change issues into account [ 50 ]. A case study of the Integrated Development Plan in the same municipality examined the working relations between the local government, civil society and private sector actors on climate change initiatives, forming a ‘network governance’ structure [ 51 ]. Having a ‘network’ helped local government shift from ruling by regulations and authority, to a ‘softer approach’, one that ‘enabled’ solutions to climate challenges. For their part, however, the private sector found it challenging to incorporate climate-sensitive actions into their modus operandi and may require financial incentives to adopt mitigation and adaptation measures. Concerns remain that the private sector - and indeed the public sector – view environmental issues as constraints to profit and development, rather than as contributors [ 50 ].

While it appears that national and local policy and planning frameworks can influence programmes and funding allocations, at least to some extent, their impact needs to be monitored closely, using appropriate indicators. These data can help decision-makers to identify programmatic areas to target, researchers to analyse and benchmark programme performance, and civil society and communities to gauge service provision in their area. The growing and shifting burden of climate-sensitive diseases, however, means that the district- and national-level indicators currently used for monitoring disease and service provision may be less relevant in this new era.

A review in 2014 emphasized the need for developing new tools for incorporating data from climate monitoring systems, for example temperature and rainfall, into Demographic Health Information Systems (DHIS) in South Africa, and vice versa [ 39 ]. The tremendous potential of integrated weather-health data is, however, constrained by differences in spatial, temporal and quality of these respective data sources. While weather data are recorded hourly and in small geographical units, [ 52 , 53 ] health data are often only available in monthly units and at district level. Analysing climate data at those resolutions results in a considerable loss of information and thus predictive ability. Challenges in collecting health data – often paper-based – means that these data are often of poorer quality than climate data, though deficiencies in climate data are not uncommon in South Africa [ 12 ]. Despite these limitations, combining climate and health data can assist with seasonal forecasting, and early warning systems for infectious diseases and other climate-related conditions.

The Infectious Diseases Early Warning System project (iDEWS) project, involving Southern African and Japanese researchers, aims to advance all these efforts, and to develop early warning system for a wide range of infectious diseases, based on climate predictions [ 54 ]. Such applications have been developed to support malaria programming in the country [ 55 ], where temporal patterns in temperature, rainfall and sea surface temperature can forecast changes in malaria incidence and the geographical expansion of disease outbreaks [ 3 , 56 , 57 ]. Further, as shown in a study in Cape Town, close monitoring of ambient temperature, can predict spikes in incidence of diarrhoeal disease, allowing health services to prepare for rises in admissions and outpatient visits [ 9 ]. Similarly, another study across several provinces noted that anomalous high rainfall precedes outbreaks of Rift Valley fever by one month and that this finding can be used to forewarn epidemics in affected areas of the country [ 58 ].

In addition to applications around infectious diseases, health and climate data are analysed in multiple-risk systems, such as the South African Risk and Vulnerability Atlas (SARVA) [ 59 ]. This spatial database allow for visualisation of the drivers, exposures, vulnerabilities, risks and hazards across different locations. SARVA provides more than just data outputs, however, and has developed a range of practical climate services for the agriculture sector, for example. Additionally, Heat–Health Warning Systems in the country, based on increasingly sophisticated meteorological systems, have long lead-times, and can alert decision-makers and the public of forthcoming extreme heat events, triggering a graded set of pre-specified actions [ 52 , 60 ].

While adaptation is classically defined as the ability to deal with change, it also encompasses the capacity to learn from it. Doing so requires investments in research and analytical systems, especially among public health practitioners. Of concern, a collaboration across several countries, including South Africa, noted that climate change and environmental health, in general, have not been mainstreamed within curricula at medical schools [ 61 ]. The group noted that, given the limited capacity in this area, international assistance maybe required to develop curricula and teaching materials. Other studies in have documented considerable gaps in knowledge on climate change among university students across disciplines and the limited ability of these future leaders to engage with others on the topic [ 62 , 63 ]. Overall, the research outputs by South Africa scientists on climate change has grown (around 600 academic publications in 2015), but only 3%, or about 20, of these publications make reference to health [ 64 ]. Of more concern, a report of the Lancet Countdown on health and climate change group, using a narrower search strategy, located only about 20 papers related to climate change and health in the whole of Africa in 2017, constituting well under 10% of the total 300 such papers worldwide [ 65 ]. Reviews have also noted that little interdisciplinary work between meteorology and health has been done [ 66 ]. But, perhaps most importantly, research investigating the performance of interventions to reduce the health impacts of climate change are largely absent [ 40 , 67 ].

Response to extreme weather events and gradual increments in temperature

We located only 8 studies applicable to this section of the review, limiting our ability to provide a comprehensive analysis on the topic at hand. This section covers disaster preparedness and responses, including of the health system, and the population groups, occupations and housing types most vulnerable to heat exposure.

The government of South Africa has developed Disaster Management Frameworks and a National Disaster Management Centre, [ 25 , 68 ] whose responsibilities include directing the country’s responses to disasters and strengthening cooperation amongst different stakeholders. There are, however, concerns that disaster risk reduction systems operate in isolation from other climate change adaptation initiatives in the country, rather than drawing on the strengths of each group [ 69 ]. While there are robust ‘Heat Health’ warning systems in the country, it appears that actual action plans or responses to heat waves require further development [ 35 , 70 ]. Some steps have been taken to develop these systems in local government areas and the private sector. A case study examining preparedness for flooding in the city of Johannesburg provides useful examples of potential synergies between the health and other sectors, but also notes considerable political barriers to cross-sectoral actions [ 71 ]. Another example of preparedness was noted in a report by a mining company that operates in several parts of the country. The company had developed substantial information, communication and technology capacity for risk assessments, and warning systems for flooding and other climate-related disasters [ 72 ].

Efforts to prepare the health system for extreme weather events or infectious disease outbreaks are hampered by weaknesses in health systems, especially in human resources for health in South Africa [ 28 ]. The recent experiences with the Listeriosis outbreak, the largest and longest lasting epidemic documented worldwide to date, brought these concerns to the fore, in particular the country’s ability to mount a swift and systematic response to disease outbreaks [ 73 ]. There were major challenges in collecting data on patient outcomes during the epidemic, for example, where the mortality status was unknown for as many as 30% of affected patients [ 74 ]. This outbreak and recent extreme weather events present many opportunities for learning. It seems, however, that these learning opportunities are often missed. A review of the responses to droughts in the country over the past century found that there have been few attempts to learn from previous droughts, and that responses to each event were largely developed de novo, rather than shaped by long-term planning and lessons from previous similar events [ 75 ].

Several populations groups and geographical areas in South Africa are especially vulnerable to the impacts of climate change. The Draft National Adaptation Strategy in 2017 and the White Paper of 2011, which presented the South African Government’s strategic vision for an effective climate change response mentions the importance of placing women and other vulnerable groups at the centre of adaptation actions. These documents, however, do not expand on this concept and no evidence was located on the differential effectiveness of adaptation interventions among women in the country, and efforts to specifically tailor adaptation measures accordingly [ 31 ]. This is concerning as many of the health and social burdens in the country are underscored by harmful gender norms, with, for example, the country has one of the highest rates of sexual violence worldwide and a very gendered HIV epidemic [ 76 ]. Few studies were located on adaption in occupational settings, many of which may become ‘moderate to high risk’ workplaces as temperatures rise [ 15 ]. A study in Johannesburg and Upington (where daily maximum temperatures may exceed 40 °C) found that outdoor workers experienced a range of heat-related effects [ 17 ]. These include sunburn, sleeplessness, irritability and exhaustion, leading to difficulty in maintaining work levels and output during very hot weather. Aside from commencing work earlier, during the cooler part of the day, no measures had been taken to protect the workers, who believed that sunglasses, wide-brimmed hats and easier access to drinking water would improve their comfort and productivity. In the mining sector in South Africa, several studies have reported that workers’ comfort and productivity can be raised with interventions such as ventilation cooling [ 77 , 78 , 79 ]. Of note, insulation within many hospital buildings has been found wanting, but little had been done to address the problem [ 80 ]. Some hospitals have taken steps to increase use of natural ventilation to adapt to temperature increases and as part of efforts to curb use of air conditioning [ 81 ]. Natural ventilation also reduces transmission of multi-drug-resistant tuberculosis, important as the country has one of the highest rates of tuberculosis worldwide [ 82 ].

Improvements in specific types of housing, especially in informal settlements, could reduce the considerable heat-health impacts of these structures, which include mortality [ 18 , 19 ]. We identified several studies on urban health in South Africa, but these did not extend to documenting the health benefits of energy efficient buildings, green spaces, public transport, car-free zones and active transport [ 71 , 83 , 84 ]. Further, many school classrooms in the country are constructed of prefabricated asbestos sheeting and corrugated iron roofs or made from converted shipping containers. A study in several parts of Johannesburg showed that heat-related symptoms are common in these structures [ 21 ]. The authors postulate that improving these structures would increase comfort for scholars and could raise educational outcomes.

The review sums the body of evidence on climate change adaptation in South Africa. We note that some steps have been taken to develop a multi-pronged strategy that cuts across health and other disciplines, and that helps adapt to the already substantial and future impacts of climate change in the country [ 42 , 85 ]. Such steps are being supported by efforts to build the resilience of vulnerable groups, who have limited ability to adapt to droughts, flooding, changes in biomes and other events [ 84 ]. While key policy frameworks are in place, it is difficult to gauge whether these have been actualized at national and local level. Increased efforts to include civil society advocates, local communities and the private sector may accelerate progress with policy implementation. In South Africa, highly-detailed data are available on weather conditions at very fine spatial and temporal resolution. Health data generally have lower resolution and quality. Additional spatial and temporal disaggregation of health information could provide invaluable data, for example, to help identify critical heat-stress thresholds in different settings and to monitor the effectiveness of action response plans. In the meantime, more evaluations, including ‘dry runs’ are needed of the health aspects of emergency response plans to extreme weather events [ 60 ]. Gaps were also noted in research infrastructure and in efforts to reduce heat exposures in some housing types and occupational settings.

The case study presented here provides useful perspectives for other countries in sub-Saharan Africa. Most especially, the findings could feed into the work of the Clim-HEALTH Africa network, which aims to share expertise, and to inform climate-sensitive policies and planning across the region [ 86 ]. While the network has already supported the development of several adaptation plans, the evidence presented here may contribute to future iterations of these plans and other network initiatives.

Strategies for extreme events – and indeed for all interventions related to climate change – need to be informed by an analysis of the implications for those living in poverty, migrants, women and children, among other groups. We noted little evidence of specific ‘targeting’ of adaptation responses to vulnerable groups. There may, for example, be benefits to specifically targeting women, as opposed to men, in early warning systems and disaster reduction plans. This approach is supported by evidence that, as with many other social interventions, it is most effective to distribute relief kits and house building grants to women [ 87 ]. In tandem with other adaptation initiatives and targeting, the overall functioning of the health system needs to be fortified, though there is much uncertainty about how this might be done [ 88 , 89 ]. The goal is to ensure that health facilities remain operational during extreme weather events, serve as places of refuge and support, and can summon the additional capacity required to deal with the impacts of extreme events. An external evaluation of the recent response to the Listeriosis outbreak might identify important lessons for improving the response to future outbreaks or extreme weather events. Potential links between climate change and that outbreak as well as future outbreaks also warrant investigation [ 73 ]. The health sector is also responsible for developing and testing heat-health guidelines for specific settings and populations, such as guidelines for sports events, which stipulate the temperature thresholds at which different sport activities should be cancelled.

Going forward, there are many opportunities to strengthen data monitoring and surveillance systems on climate and health. The Lancet Countdown has developed indicators to monitor national-level progress on climate change in the health sector [ 90 ]. Six of these pertain to adaptation and correspond broadly to the sections of this paper: 1. National adaptation plans for health; 2. City-level climate change risk assessments; 3. Detection and early warning of, preparedness for, and response to health emergencies; 4. Climate information services for health; 5. National assessment of vulnerability, impacts and adaptation for health; and 6. Climate-resilient health infrastructure. This paper suggests that additional work is required in each of these areas in South Africa. These indicators – and the full Lancet Countdown framework – could be used to benchmark the country’s progress against other nations and to pinpoint the specific areas requiring attention [ 91 ]. Monitoring data could be used to produce annual estimates of the burden of disease and health costs that would be averted by more vigorous climate change mitigation or adaptation efforts [ 92 ]. Such disease prediction models have been used with great effect in the HIV epidemic [ 93 ], where they generated considerable pressure on the government and international donors to prioritise actions and resource allocations accordingly. Additionally, given the vulnerabilities of food security to climate change in South Africa, close monitoring is needed of under-nutrition, agriculture and marine productivity [ 14 , 94 ].

An adequate adaptation response is contingent on the progressive accrual of robust evidence. This, in turn, depends on earmarked funding for research on climate change and health, agile and responsive research systems and, indeed, an adequate number of capacitated researchers. Given the growing attention paid to this field, high-quality evidence with compelling findings could rapidly foment policy changes. Moreover, if the quality and volume of research were raised, it will become possible to make evidence-based national policies, as in other health fields. The health sector in South Africa, with its considerable research capacity, is well placed to lead such efforts. To achieve this, however, researchers in other health fields, such as HIV, for example, would need to take on projects on climate change. As a first step, it may be useful to convene consultations of experts in health, the environment and related fields to develop broad plans for taking advantage of opportunities for cross-learning and action. Some targeted research funding for joint health and environmental projects on climate change could have a considerable impact. The iDEWS project offers an important example of such an initiative [ 54 ]. In the long run, research in this field could be sustained by allocating more time to climate change topics in training programmes for health workers and public health practitioners.

While the review highlights some important findings, the limited number of papers located suggests that the country has some way to go to fulfilling its potential leadership role on the continent, and indeed globally. One area that health practitioners in South Africa could lead on is the promotion of a ‘meat tax’, given their pioneering work on the ‘sugar tax’ [ 95 ]. Curbing the intake of ruminant meat is a key climate change mitigation strategy and would lower cancer risks, among other health benefits [ 96 ]. This is important in South Africa, where an estimated total of 875,000 tons of beef are consumed annually [ 97 ], producing 648 gigagrams of methane [ 98 ]. The principal arguments for a sugar tax – and indeed for tobacco and alcohol taxes – hold for ruminant meat: harm to self and others, and the considerable cost burdens on broader society [ 99 ]. In this case, the harms are mediated through environmental destruction, a change in climate and cancer, amongst others [ 95 ]. Such policies are, however, likely to be vigorously opposed by the meat industry in South Africa, and public health and environmental and social justice experts in the country will need to rally together [ 26 ]. Bringing together the complementary skills of these experts has the potential for powerful synergies and for drawing additional researchers into the climate change and health arena. Similarly, broadening the scope of climate change adaptation to encompass existing programmes that have an indirect impact on climate change adaptation would also increase the number of climate adaption workers. This would also assist in mainstreaming climate change into existing health programmes, and highlight additional ways that the health sector has successfully responded to the problem. Increased attention to these successes might demonstrate the extent to which the sector is leading the field and its potential contribution to overall adaptation efforts in the country.

The study has some limitations. The limited number of papers included in the review ( n  = 22) and the heterogeneous nature of the evidence constrained our ability to draw overall conclusions about the adaption response to date. Likely many additional studies on the topic are published in grey literature sources or unpublished and would thus not be in our search. Moreover, the search would not have located studies of interventions by the health sector that indirectly reduce the impact of climate change, but have not been framed as such. These intervention may include socio-economic initiatives that build financial resilience of households, improvements in housing and control of infectious diseases.

In fact, explicitly framing existing programmes that have an indirect impact on climate change adaptation as contributing to climate change adaptation.

The review highlights several important gaps in adaptation practices. While policy and planning frameworks for climate change at national, provincial and local level do make mention of health priorities, the health sector does not yet appear to be viewed as an essential platform for adaption measures, and health concerns appear to be accorded low priority. We did, however, note several important examples of health sector involvement in adaptation initiatives within local area government and in occupational settings. Importantly, there have been few rigorous evaluations of the effectiveness of actual interventions on climate adaptation for the health sector; most studies are descriptive in nature. Perhaps the largest knowledge gap is evidence around the effectiveness of disaster management systems and the level of preparedness of these systems for extreme weather events. The lack of studies on that and other topics may reflect the nascent nature of the field and that the priority given to climate-sensitive conditions in training for health workers and public health practitioners has not reflected the present and future burden of these conditions.

Clearly, interventions targeting the direct impacts of climate change need to occur in tandem with actions to shore up the resilience of the population and health system. Many health sector initiatives targeting those areas already contribute to climate adaptation, albeit indirectly so. Highlighting the successes of these initiatives and explicitly framing them as part of climate adaptation could mainstream climate change into existing programmes and provide examples of the ways in which the country is already successfully responding to the problem. Reframing in this manner may generate the leadership and momentum necessary for making rapid advances in this field.

Indeed, increased health sector leadership and lobbying may prove pivotal in advancing the adaptation field per se. The explicit framing of climate change adaptation and mitigation as critical to protecting the health of the nation may secure a more vigorous policy and programmatic response by government, and strengthen the engagement of civil society and communities [ 36 ]. Health could be placed firmly at the centre of policies for climate change adaptation and mitigation. Equally, effective leadership would mainstream climate change considerations into all policies for health [ 37 ]. High-quality research, involving a range of disciplines and backed by local and international funding, could go a long way to securing these changes.

While the country has led the way globally in HIV and several other arenas, it has yet to fully assume a leadership role in this field. With increased focus, the health sector could use its considerable influence to advocate for policy change and improved climate governance: it’s time for health to take a lead.

Abbreviations

Demographic Health Information System

Human Immunodeficiency Virus

Infectious Diseases Early Warning System project

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Chersich, M.F., Wright, C.Y. Climate change adaptation in South Africa: a case study on the role of the health sector. Global Health 15 , 22 (2019). https://doi.org/10.1186/s12992-019-0466-x

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COP26 Case Studies on Climate Change and Health

The science is clear: we must urgently scale up action to respond to the threat of climate change to have a chance of limiting warming to 1.5 degrees, and to adapt effectively and increase our resilience. Moreover, the public health motives for action have a strong science basis and are well evidenced and compelling.

In this briefing pack,  a series of case studies and opportunities for sharing experiences on climate change and health are highlighted  across five priority areas of climate action: adaptation &  resilience, energy transitions, nature, clean transport, and finance.  This briefing pack highlights the health benefits of action in those areas, and hopes to contribute towards collective progress in the lead up to the 26th UN Climate Change Conference of the Parties (COP26).

This document was produced by UK Government with contributions from WHO, Wellcome Trust, London School of Hygiene and Tropical Medicine and the Global Climate and Health Alliance. Please note, that some of the case studies may be developed further over time.

Published in November 2020

COP26 Key Messages on Climate Change and Health

Summary Slide - COP26 Campaign Aims and Health Asks

Race to Zero Dialogue on Climate and Health

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11 min read

Seven case studies in carbon and climate

Every part of the mosaic of Earth's surface — ocean and land, Arctic and tropics, forest and grassland — absorbs and releases carbon in a different way. Wild-card events such as massive wildfires and drought complicate the global picture even more. To better predict future climate, we need to understand how Earth's ecosystems will change as the climate warms and how extreme events will shape and interact with the future environment. Here are seven pressing concerns.

The Far North is warming twice as fast as the rest of Earth, on average. With a 5-year Arctic airborne observing campaign just wrapping up and a 10-year campaign just starting that will integrate airborne, satellite and surface measurements, NASA is using unprecedented resources to discover how the drastic changes in Arctic carbon are likely to influence our climatic future.

Wildfires have become common in the North. Because firefighting is so difficult in remote areas, many of these fires burn unchecked for months, throwing huge plumes of carbon into the atmosphere. A recent report found a nearly 10-fold increase in the number of large fires in the Arctic region over the last 50 years, and the total area burned by fires is increasing annually.

Organic carbon from plant and animal remains is preserved for millennia in frozen Arctic soil, too cold to decompose. Arctic soils known as permafrost contain more carbon than there is in Earth's atmosphere today. As the frozen landscape continues to thaw, the likelihood increases that not only fires but decomposition will create Arctic atmospheric emissions rivaling those of fossil fuels. The chemical form these emissions take — carbon dioxide or methane — will make a big difference in how much greenhouse warming they create.

Initial results from NASA's Carbon in Arctic Reservoirs Vulnerability Experiment (CARVE) airborne campaign have allayed concerns that large bursts of methane, a more potent greenhouse gas, are already being released from thawing Arctic soils. CARVE principal investigator Charles Miller of NASA's Jet Propulsion Laboratory (JPL), Pasadena, California, is looking forward to NASA's ABoVE field campaign (Arctic Boreal Vulnerability Experiment) to gain more insight. "CARVE just scratched the surface, compared to what ABoVE will do," Miller said.

Methane is the Billy the Kid of carbon-containing greenhouse gases: it does a lot of damage in a short life. There's much less of it in Earth's atmosphere than there is carbon dioxide, but molecule for molecule, it causes far more greenhouse warming than CO 2 does over its average 10-year life span in the atmosphere.

Methane is produced by bacteria that decompose organic material in damp places with little or no oxygen, such as freshwater marshes and the stomachs of cows. Currently, over half of atmospheric methane comes from human-related sources, such as livestock, rice farming, landfills and leaks of natural gas. Natural sources include termites and wetlands. Because of increasing human sources, the atmospheric concentration of methane has doubled in the last 200 years to a level not seen on our planet for 650,000 years.

Locating and measuring human emissions of methane are significant challenges. NASA's Carbon Monitoring System is funding several projects testing new technologies and techniques to improve our ability to monitor the colorless gas and help decision makers pinpoint sources of emissions. One project, led by Daniel Jacob of Harvard University, used satellite observations of methane to infer emissions over North America. The research found that human methane emissions in eastern Texas were 50 to 100 percent higher than previous estimates. "This study shows the potential of satellite observations to assess how methane emissions are changing," said Kevin Bowman, a JPL research scientist who was a coauthor of the study.

Tropical forests

Tropical forests are carbon storage heavyweights. The Amazon in South America alone absorbs a quarter of all carbon dioxide that ends up on land. Forests in Asia and Africa also do their part in "breathing in" as much carbon dioxide as possible and using it to grow.

However, there is evidence that tropical forests may be reaching some kind of limit to growth. While growth rates in temperate and boreal forests continue to increase, trees in the Amazon have been growing more slowly in recent years. They've also been dying sooner. That's partly because the forest was stressed by two severe droughts in 2005 and 2010 — so severe that the Amazon emitted more carbon overall than it absorbed during those years, due to increased fires and reduced growth. Those unprecedented droughts may have been only a foretaste of what is ahead, because models predict that droughts will increase in frequency and severity in the future.

In the past 40-50 years, the greatest threat to tropical rainforests has been not climate but humans, and here the news from the Amazon is better. Brazil has reduced Amazon deforestation in its territory by 60 to 70 percent since 2004, despite troubling increases in the last three years. According to Doug Morton, a scientist at NASA's Goddard Space Flight Center in Greenbelt, Maryland, further reductions may not make a marked difference in the global carbon budget. "No one wants to abandon efforts to preserve and protect the tropical forests," he said. "But doing that with the expectation that [it] is a meaningful way to address global greenhouse gas emissions has become less defensible."

In the last few years, Brazil's progress has left Indonesia the distinction of being the nation with the highest deforestation rate and also with the largest overall area of forest cleared in the world. Although Indonesia's forests are only a quarter to a fifth the extent of the Amazon, fires there emit massive amounts of carbon, because about half of the Indonesian forests grow on carbon-rich peat. A recent study estimated that this fall, daily greenhouse gas emissions from recent Indonesian fires regularly surpassed daily emissions from the entire United States.

Wildfires are natural and necessary for some forest ecosystems, keeping them healthy by fertilizing soil, clearing ground for young plants, and allowing species to germinate and reproduce. Like the carbon cycle itself, fires are being pushed out of their normal roles by climate change. Shorter winters and higher temperatures during the other seasons lead to drier vegetation and soils. Globally, fire seasons are almost 20 percent longer today, on average, than they were 35 years ago.

Currently, wildfires are estimated to spew 2 to 4 billion tons of carbon into the atmosphere each year on average — about half as much as is emitted by fossil fuel burning. Large as that number is, it's just the beginning of the impact of fires on the carbon cycle. As a burned forest regrows, decades will pass before it reaches its former levels of carbon absorption. If the area is cleared for agriculture, the croplands will never absorb as much carbon as the forest did.

As atmospheric carbon dioxide continues to increase and global temperatures warm, climate models show the threat of wildfires increasing throughout this century. In Earth's more arid regions like the U.S. West, rising temperatures will continue to dry out vegetation so fires start and burn more easily. In Arctic and boreal ecosystems, intense wildfires are burning not just the trees, but also the carbon-rich soil itself, accelerating the thaw of permafrost, and dumping even more carbon dioxide and methane into the atmosphere.

North American forests

With decades of Landsat satellite imagery at their fingertips, researchers can track changes to North American forests since the mid-1980s. A warming climate is making its presence known.

Through the North American Forest Dynamics project, and a dataset based on Landsat imagery released this earlier this month, researchers can track where tree cover is disappearing through logging, wildfires, windstorms, insect outbreaks, drought, mountaintop mining, and people clearing land for development and agriculture. Equally, they can see where forests are growing back over past logging projects, abandoned croplands and other previously disturbed areas.

"One takeaway from the project is how active U.S. forests are, and how young American forests are," said Jeff Masek of Goddard, one of the project’s principal investigators along with researchers from the University of Maryland and the U.S. Forest Service. In the Southeast, fast-growing tree farms illustrate a human influence on the forest life cycle. In the West, however, much of the forest disturbance is directly or indirectly tied to climate. Wildfires stretched across more acres in Alaska this year than they have in any other year in the satellite record. Insects and drought have turned green forests brown in the Rocky Mountains. In the Southwest, pinyon-juniper forests have died back due to drought.

Scientists are studying North American forests and the carbon they store with other remote sensing instruments. With radars and lidars, which measure height of vegetation from satellite or airborne platforms, they can calculate how much biomass — the total amount of plant material, like trunks, stems and leaves — these forests contain. Then, models looking at how fast forests are growing or shrinking can calculate carbon uptake and release into the atmosphere. An instrument planned to fly on the International Space Station (ISS), called the Global Ecosystem Dynamics Investigation (GEDI) lidar, will measure tree height from orbit, and a second ISS mission called the Ecosystem Spaceborne Thermal Radiometer Experiment on Space Station (ECOSTRESS) will monitor how forests are using water, an indicator of their carbon uptake during growth. Two other upcoming radar satellite missions (the NASA-ISRO SAR radar, or NISAR, and the European Space Agency’s BIOMASS radar) will provide even more complementary, comprehensive information on vegetation.

Ocean carbon absorption

When carbon-dioxide-rich air meets seawater containing less carbon dioxide, the greenhouse gas diffuses from the atmosphere into the ocean as irresistibly as a ball rolls downhill. Today, about a quarter of human-produced carbon dioxide emissions get absorbed into the ocean. Once the carbon is in the water, it can stay there for hundreds of years.

Warm, CO 2 -rich surface water flows in ocean currents to colder parts of the globe, releasing its heat along the way. In the polar regions, the now-cool water sinks several miles deep, carrying its carbon burden to the depths. Eventually, that same water wells up far away and returns carbon to the surface; but the entire trip is thought to take about a thousand years. In other words, water upwelling today dates from the Middle Ages – long before fossil fuel emissions.

That's good for the atmosphere, but the ocean pays a heavy price for absorbing so much carbon: acidification. Carbon dioxide reacts chemically with seawater to make the water more acidic. This fundamental change threatens many marine creatures. The chain of chemical reactions ends up reducing the amount of a particular form of carbon — the carbonate ion — that these organisms need to make shells and skeletons. Dubbed the “other carbon dioxide problem,” ocean acidification has potential impacts on millions of people who depend on the ocean for food and resources.

Phytoplankton

Microscopic, aquatic plants called phytoplankton are another way that ocean ecosystems absorb carbon dioxide emissions. Phytoplankton float with currents, consuming carbon dioxide as they grow. They are at the base of the ocean's food chain, eaten by tiny animals called zooplankton that are then consumed by larger species. When phytoplankton and zooplankton die, they may sink to the ocean floor, taking the carbon stored in their bodies with them.

Satellite instruments like the Moderate resolution Imaging Spectroradiometer (MODIS) on NASA's Terra and Aqua let us observe ocean color, which researchers can use to estimate abundance — more green equals more phytoplankton. But not all phytoplankton are equal. Some bigger species, like diatoms, need more nutrients in the surface waters. The bigger species also are generally heavier so more readily sink to the ocean floor.

As ocean currents change, however, the layers of surface water that have the right mix of sunlight, temperature and nutrients for phytoplankton to thrive are changing as well. “In the Northern Hemisphere, there’s a declining trend in phytoplankton,” said Cecile Rousseaux, an oceanographer with the Global Modeling and Assimilation Office at Goddard. She used models to determine that the decline at the highest latitudes was due to a decrease in abundance of diatoms. One future mission, the Pre-Aerosol, Clouds, and ocean Ecosystem (PACE) satellite, will use instruments designed to see shades of color in the ocean — and through that, allow scientists to better quantify different phytoplankton species.

In the Arctic, however, phytoplankton may be increasing due to climate change. The NASA-sponsored Impacts of Climate on the Eco-Systems and Chemistry of the Arctic Pacific Environment (ICESCAPE) expedition on a U.S. Coast Guard icebreaker in 2010 and 2011 found unprecedented phytoplankton blooms under about three feet (a meter) of sea ice off Alaska. Scientists think this unusually thin ice allows sunlight to filter down to the water, catalyzing plant blooms where they had never been observed before.

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The relevance of case studies in climate change research: a review of policy recommendations

• Review Paper
• Published: 10 September 2019
• Volume 1 , article number  1197 , ( 2019 )

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• Jose Daniel Teodoro 1 ,
• Donal S. O’Leary III 1 ,
• Siobhan E. Kerr 2 ,
• Eva Peskin 3 &
• Julie A. Silva 1  

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In the age of big data, case studies build the foundation for the large-scale models that are increasingly being used for decision and policymaking. In this systematic literature review, we investigated the geographic, methodological, and conceptual characteristics of case studies in climate change science to evaluate the extent they provide policy recommendations to answer the questions: how can researchers best gather and report policy - relevant information for climate change adaptation, resilience, and/or recovery? What are the current themes within the literature, and how can these areas best advance as policy - relevant fields within climate change science? Findings highlight that policy recommendations were more robust, and significantly more likely, in case studies that employ participatory research methods; and geographic characteristics and use of theoretical frameworks are associated with providing policy recommendations. On the other hand, studies that focus on biophysical parameters of climate change offered weak or no policy recommendations. Thus, we conclude that local-level case study research can serve as validation and calibration data for large-scale models as long as they accurately represent the local values and perceptions of the people in the study area. We elaborate on the opportunities that exist in non-human, biophysical, research for communicating findings to policy-friendly audiences.

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1 Introduction

Anthropogenic climate change is a threat to all humans, causing risk to land quality, personal property, and livelihoods [ 1 , p. 80, 2 ]. The human capacity to adapt to these changes, remain resilient, and recover from climate disturbance is critical for the survival of communities, cultures, and countries in the twenty first century. In such a pursuit, scientists have ventured in studying different ways in which communities around the world mitigate and adapt to climate change’s dangerous impacts, such as novel forms of participatory governance [ 3 ], finding adaptation and mitigation synergies that increase carbon sequestration potential [ 4 ], understanding the role of social networks in climate communication [ 5 , 6 ], and identifying the benefits of community driven natural resource conservation programs [ 7 ]. Designing and enforcing policies that address the severity of climate change impacts is a complex process, and despite the abundance of examples in the literature policymakers may be hesitant to implement new regulations without practical and actionable evidence in support of their efforts [ 8 ]. As a result, there has been an increasing interest in policy-relevant scientific research supporting climate change resilience and adaptation at the local and global scales [ 9 , 10 ].

With the beginning of the digital revolution, policy-makers have been increasingly recognizing the potential of big data analytical methods to support their decisions, including climate-forecasting global circulation models [ 11 , p. 159], natural resource life cycle modelling [ 12 ], and social networking models [ 13 ]. The advancement of such models and techniques offers an unprecedented insight into regional and global phenomena [ 14 ]. Still, models like these are still in the earlier stages of development and require calibration and validation through the comparison with local data, which are most often generated through fieldwork and case study research [e.g., 15 ]. Such case studies run the gamut from systematic evaluations of timber harvest efficiency and succession [ 16 ], to local and regional surveys regarding human health and well-being [ 17 ]. The policy implications of a new landscape of small and big data are yet to be fully materialized. However, the degree and quality of policy engagement in recently published climate change research begin to unravel the role local-level data can play in policy-making in the digital age.

In this article, we systematically review case studies in climate change science to evaluate the relationship between the methodological characteristics of a study and the extent they provide implementable policy recommendations to answer the questions: In what ways is (case study) research design associated with reporting policy - relevant information for climate change adaptation, resilience, and/or recovery? What themes stand out within the literature in relation to engaging with climate change adaptation or mitigation policies, and how can these areas best advance as policy - driven foci within climate change science? The review includes a meta-analysis of climate change research on adaptation, resilience, and recovery that involve field data from case studies or study sites (e.g., sample plots) published between 2012 and 2017. The objectives of the systematic review were (1) to synthesize recent climate change research using case study or field site data to provide a general description of this body of literature; (2) gauge the extent to which research involving case and field study data provide policy recommendations, and how this varies by study characteristics; (3) assess how researchers integrate local-level data with secondary sources and; (4) qualitatively describe insights in case study research based on nuanced themes within the reviewed articles.

Our study stands out in two specific ways: First, our approach combines analysis of studies involving human and non-human actors. Second, the unique composition of the research team embodied interdisciplinary perspectives used to review and analyze the existing body of literature. Our results aim to inform researchers who desire to make explicit linkages between scientific findings and policy formulation, whether they are ‘foot soldiers’ collecting data in the field, or ‘big data’ analysts working to inform their models using case study data.

This review article blends systematic meta-analysis [ 18 ] with a focused qualitative approach [e.g., 19 ] in order to provide both statistical analysis of the evaluated literature and a nuanced qualitative assessment of some selected themes that emerged from the reviewed work. An interdisciplinary research team representing ecology, geography, public policy, and women’s studies conducted the review of climate change research involving case studies of human populations and/or the collection of biophysical field data. The research team met weekly from January to May, in 2017, to develop consensus regarding classification schemes, harmonize data collection, discuss findings, and engage in team-building exercises to facilitate interdisciplinary collaboration. The following section describes the article selection process, including the inclusion and exclusion criteria, the process used to make the final determination of the article sample, data collection, statistical analysis and thematic foci for the qualitative review component.

2.1 Document selection and review

The title, abstract, and keywords of all peer-reviewed English articles indexed in the Web of Science SCI-EXPANDED, SSCI search engines were searched using the following code:

For the purposes of our analysis, case studies were defined following Yin [ 20 , p. 13] as an empirical inquiry investigating a contemporary issue within its real-life context by collecting data from individuals. The term study area was used to allow for the inclusion of research conducted in a specific geographically delimited area because it is representative of a larger ecological system.

The search was restricted to include only articles published between 2012 and 2017 in journals classified in at least one of the following Web of Science categories:

The basis for the journal classification selection involved an assessment of the journal outlets publishing climate change research involving case studies and other field data collection by both social and physical scientists. Figure  1 outlines the selection and review process in 5 phases. All potentially relevant articles identified in phase 1 were segmented into four categories using the bibliometric and visualization software VOSviewer [ 21 ]. This method clustered articles based on similarities between the works cited. Bibliometric clustering resulted in four article groupings unified by overarching themes. The team identified the main themes of each cluster based on a joint review of cited references and ten randomly sampled articles from each. The four clusters were assigned to members of the research team with the most demonstrated expertise in that area. The member of the team with the broadest range of research experience reviewed all articles, which ensured independent data screening by two analysts in all subsequent steps.

Flow chart of the article selection and screening phases

Drawing on the methodology described by Brandt et al. [ 22 ], two readers reviewed each abstract based on questions to identify relevant articles (Fig.  1 ). Team members discussed assessments of the inclusion criteria at weekly team meetings to ensure consistent interpretations. Questionable cases that arose throughout the process were discussed and cleared during meetings. In cases where a decision of inclusion/exclusion for a specific article differed between the two independent readers, additional time was allocated to arrive at a consensus-based decision. After completing the initial review of the abstracts, the team collectively reassigned some select papers based on their thematic area. During the previous phase, both reviewers noted when the topic of an article fell within the area of expertise of another member of the research team. All reassignments were based on team discussions and consensus.

All articles included in the sample were then downloaded and assessed independently by two reviewers using a pre-designed rubric to capture quantitative, qualitative, close-ended categorical data, and open-ended notes or comments (Supplementary Material 1). The rubric included questions regarding the characteristics of the author(s), the case studies conducted, the data collection and analytical methods employed, the stated policy implications of the research, and other factors. As in phase 3, the second reviewer read all articles in the sample in order to ensure continuity between the four different thematic clusters. In addition, some articles were excluded from the sample if the team determined, after a review of the full article, that it failed to meet the inclusion criteria outlined in phase 3. As with the previous phase, team members had weekly discussions regarding any questions that arose during the coding process to ensure a uniform analysis. A final sample of 155 articles was selected for coding and analysis (Supplementary Material 2).

2.2 Analytical approach

2.2.1 systematic meta-analysis review.

After the article selection and coding process was completed, data from the review rubric were entered into a database for analysis. Descriptive statistics were used to describe the overall sample of articles. Cross-tabulations were used to examine how article characteristics (e.g., geographic region of study, spatial scope, rural or urban focus, data collection techniques, and methodological approaches) varied for articles employing case studies, field studies, or a combination of both. Chi square ( χ 2 ) and Fisher’s exact tests were conducted to identify statistically significant associations between article characteristics and the inclusion of policy recommendations. All p values refer to χ 2 tests unless otherwise indicated. The software SAS was used for all statistical analyses.

2.2.2 A qualitative review of selected themes

Following the example of Brown [ 19 ], this review discusses selective themes that emerged from the overall sample to illustrate in more detail the associations found in the analysis. This component of the review involved four team members from different disciplines conducting separate, in-depth assessments of selected articles which were then discussed and synthesized into a collective discussion below. The approach taken for the qualitative review allowed the team members, each with different disciplinary perspectives and backgrounds, to critically reflect on the literature they found to be illustrative of an insightful theme that emerged during the systematic review of the articles. Team members discussed the content of the qualitative reviews at weekly team meetings.

3.1 Descriptive characteristics of the dataset

Descriptive statistics of the final sample ( n  =155) show that 73% of the articles exclusively collected and analyzed primary data from individuals (In this article, we call these human studies), 15% focused on biophysical data from field sites (non-human studies), and the remaining 12% used both types of data (coupled studies). Figure  2 summarizes the geographical focus of the reviewed articles using the World Bank’s regional classification system. Figure  3 shows the relationship between the first author’s geographic region, the type of study, and the region where the study took place. From our sample, 70% of articles discussed the policy implications of their research or made recommendations decision-makers based on presented findings; although the degree to which articles engaged with policy varied substantially across the sample.

Geographic distribution of the affiliation of first authors (top) and region where the study took place (bottom)

Descriptive distribution of a country of the first author, b type of article (i.e., human, biophysical, or coupled studies), and c country where the study took place

In broad geographical terms, the majority of first authors were affiliated with institutions in Europe or Central Asia (36%), followed by East Asia and the Pacific (mainly Australia) and North America (25% and 25%, respectively). These three regions accounted for the majority of first authors in all subcategories, with almost half of the natural systems studies (48%) first authored by someone with institutional affiliation in Europe or Central Asia. When looking at where studies took place, East Asia and the Pacific had the greatest overall coverage (26%) and this region was the focus of the largest share of human systems studies (26%) and the second largest share of coupled human-natural systems studies (23%). The largest number of natural systems studies focused on locations within Europe and Central Asia (33%). Of the reviewed articles, only 1% had a study area located in the Middle East or in North Africa; only two human studies taking place in this regional grouping.

3.2 Statistical relationships

Few geographic characteristics have statistically significant associations with whether or not the article provided policy recommendations. Articles involving a case study or field site within Sub-Saharan Africa ( p  = 0.034) or a first author with an institutional affiliation there ( p  = 0.033, Fischer) were more likely to include policy recommendations. Indeed, all ten papers first authored by someone affiliated with the region did so. The opposite relationship was true for articles with study areas located in Europe and Central Asia ( p  = 0.008) or first authors affiliated with institutions in this region ( p  = 0.004). Despite the common critique that case studies prioritize the local level [ 23 , 24 ], 70% of the articles conducted research at the regional scale (extra-local but still subnational). The relationship between the scale of analysis (i.e., local or regional) and providing policy recommendations was not significant.

Scientific collaboration across fields was prevalent in our sample. Multidisciplinary teams authored 60% of the articles and 78% of the biophysical systems studies. The majority of articles had at least one author with an institutional affiliation where the study took place (79%), and that figure is even higher for biophysical systems studies (96%). Nevertheless, there was no statistical association between the multidisciplinary composition of authors, their institutional affiliation, and providing policy recommendations.

Methodological characteristics, like analytical frameworks and data collection, emerged as important characteristics associated with policy recommendations. Methodological representation was evenly divided between studies using quantitative approaches (33%), qualitative approaches (35%), or a blend of both (32%). However, as would be expected given the use of biophysical data, all non-human studies employed quantitative methodologies. Overall, studies using quantitative methodologies ( p  = 0.000) were less likely to highlight the policy relevance of the reported research. In contrast, data collection and methodological approaches associated with human studies, such as the participatory activities/exercises ( p  = 0.003), focus groups ( p  = 0.001), and the use of ethnographic techniques ( p  = 0.002) were all more likely to discuss policy. Human studies ( p  = 0.000) were more likely than natural or coupled studies to include policy recommendations or discuss the policy implications of the research.

Exactly half of the articles explicitly mentioned the theory or conceptual framework guiding the research. These articles that referenced the theory or conceptual framework ( p  = 0.008) or discuss power asymmetries or structural inequalities that exacerbate the impacts of climate change ( p  = 0.084) were more likely to provide policy recommendations, but these characteristics were almost exclusively found in human studies.

When analyzing only the subset of human studies articles, a research methodology that included some kind of participatory activities ( p  = 0.079) and focus groups ( p  = 0.029) remain significantly more likely to provide policy recommendations. Only one relationship emerged as statistically significant within the human studies subset while insignificant for the overall sample: urban versus rural focus. Articles with case studies in rural areas ( p  = 0.019, Fischer) were more likely to make policy recommendations than those exclusively focused on urban areas.

The overall sample was evenly split between studies using only primary data (50%) and those integrating primary and secondary data sources (50%). However, the type of data had no significant association with policy engagement. This was true for the entire sample and for all three of the study subsets (i.e., human, biophysical, and coupled). Core concepts did display an association with policy engagement, with articles addressing adaptation ( p  = 0.003) more likely to do so and those addressing recovery ( p  = 0.019, Fischer) were less likely. However, most of these associations were not statistically significant within the three study subsets.

4 Emerging themes in the literature

The results from the meta-analysis broadly suggest that geographic location of study and affiliation of authors, the methodology employed, theoretically-framed research, and the type of data collected are all significant characteristics that are associated with research-policy integration through policy recommendations. The most apparent finding is the clear distinction between human and non-human studies, with the former being more likely to provide policy recommendations than the latter. The qualitative assessment of trends and themes in climate change adaptation and resilience literature is a useful mechanism to unpack these associations with nuance and with the aim of synthesizing our findings.

4.1 Human-oriented studies most likely to offer policy recommendations

When unpacking the significant characteristics of the human studies, Gibson-Graham’s [ 25 ] formulation of the “ethics of the local” is a helpful conceptual tool to imagine how locally focused research can have broader social and economic transformative significance. The Ethics of the Local primarily acknowledges the particularity of the “local” recognizing the difference and otherness with the intention of cultivating local capacity [ 25 ]. Particularity and contingency were demonstrated by reviewed studies that employed ethnographic methodologies that helped understand specific circumstances of different communities around the world [ 7 , 26 , 27 ]. Some case studies include clear policy recommendations that aimed at cultivating local capacity and reducing vulnerability [e.g., 28 ], while increasing the participation of local stakeholders in the research process. In this sense, these case studies sought not only to describe a scientific reality but also to influence and transform the social-environmental regime of that locality. Evidently, each case study highlights findings which are to some degree generalizable yet reinforce the specific conditions of each place.

Within the human studies sub-sample, a clear divide emerged between articles focused on urban high-income or rural low-income communities. In particular, researcher differed in the way elicited knowledge and perceptions from local inhabitants regarding climate change. In the former, researchers generally asked respondents to consider climate change as a broad, long-term scientific phenomenon, while in the latter the focus was more on asking about recent changes in the weather. Many of the studies conducted in rural or low-income study areas asked respondents questions such as whether they had observed rising temperatures [ 29 ], if rainfall had become more variable [ 30 ] or if drought was more frequent [ 31 ]. When researching rural low-income communities, the authors did not acknowledge or justify their decision to focus on observable variability rather than on long-term trends. This may be related to the way people understand climate change effects based on geographical location. Regardless, the apparent lack of consistency in methodology presents challenges to researchers or policy-makers who wish to understand how climate change is affecting livelihoods in a broader sense. Given this inconsistency, attempts to compare research results from different geographic areas will become increasingly challenging. Thus, designing and enforcing climate adaptation policy may broadly benefit from a greater integration of lessons learned from urban high-income and rural low-income communities.

4.2 Participatory methods are associated with policy recommendations

Data collection methods that are most commonly associated with human studies include interviews, surveys, focus groups and workshops, all of these are significantly associated with providing policy recommendations. These methods were employed in articles which engaged with communities and investigated how changes in climate are experienced by people at the local level. Based on the reviewed literature, it is clear that the weather today presents more and different challenges than it did in the past. These findings show that, overall, people quite accurately perceive the degree and magnitude of changes in the weather [ 32 , 33 , 34 ]. Case studies that used historical meteorological data for validation found that weather changes described by the community were generally correct [ 28 , 35 , 36 ]. This suggests that case study research have the potential to provide valuable information for climate change science, particularly in areas with limited long-term meteorological data. As such, participatory methods have the capacity to uncover relevant aspects of the local social life [ 37 ].

Some of the methods employed target local perceptions as a way to understand local values and past experiences that influence the way communities engage with governance structures and how they ultimately address climate change impacts [ 38 , 39 ]. Our analysis shows the importance of using local-level perception data to inform regional adaptation policies in ways that account for local priorities and needs [ 38 , 40 , 41 ]. Research in this area highlights the long-term benefits of employing participatory methods that support adaptive environmental management [ 38 , 42 , 43 ]. Openness to a diversity of views and perceptions can empower marginalized stakeholders and promote learning among diverse stakeholders about the trade-offs and benefits of different adaptation options. In addition, participatory research that facilitates the interaction among stakeholders with different views may contribute to building cooperation between individuals or groups with opposing interests [ 44 , 45 ].

Participatory research methods also promote local participation in areas where there are contentious, often opposing, views on how to address climate change risks and vulnerability [ 46 , 47 ]. Case study research that brings together scientists, policymakers, and local inhabitants through participatory methodologies like focus groups and workshops tend to provide opportunities to incorporate local knowledge into management processes [ 48 , 49 ]. These approaches have gained attention in policy and practitioner circles for their capacity to engage with multiple stakeholders and direct research in ways that benefit the overall community [ 10 ]. Moreover, these approaches have the potential to help identify awareness and information gaps among stakeholders, which may help in crafting tailored communication across different types of stakeholders and support the successful implementation of adaptation strategies [ 49 ].

Taken together, the human studies reviewed in this article that employ participatory research methods are strongly associated with providing policy recommendations. Further research is necessary to unpack and understand this trend. Nonetheless, integrating local participation in climate change adaptation is likely to facilitate discussion and learning on the appropriate responses to climate impacts.

4.3 Policy potential for carbon sequestration

Even though biophysical, non-human, studies did not have a statistically significant association with providing policy recommendations, some did employ qualitative forms of engagement with local actors. Within the biophysical subsample, carbon sequestration emerged as a prominent research focus. While local efforts to mitigate carbon emissions make a small difference to the global carbon budget, the potential for wide-reaching policies to make an impact remains large. There are three studies that focused on the decision-making process behind forest carbon management, though they found that carbon-smart policies were implemented with varying levels of success [ 7 , 50 , 51 ]. Each of the three studies interviewed forest managers, gaining insight into the on-the-ground management practices that drive long-term carbon retention and sequestration. Ellenwood et al. [ 50 ] interviewed federal forest managers in Durango, Colorado, USA and found that, while there is widespread interest in carbon sequestration, few management decisions are focused on these goals. Milad et al. [ 51 ] found similar results when interviewing forest managers across Germany.

Pandey et al. [ 7 ] focused on a set of community forests, rather than exclusive nationally-controlled forests (as in the USA and Germany), in Nepal, as they implemented new Reduced Emissions from Deforestation and forest Degradation (REDD +) policies. Their study combined interviews with field measurements of below- and above-ground forest carbon density as they studied the carbon sequestration effects of a locally-empowering policy shift. They found that by implementing carbon-smart strategies they were able to sequester more carbon while simultaneously empowering the poorest farmers; a true win–win. In this comparison, it was the developing country (Nepal) that had a far more effective carbon-smart forest management practice, compared to the two developed nations (USA and Germany). These findings suggest that, while national-level policies have the potential to make a large impact, they can be slow to implement. Conversely, community-level management can be quick to adapt to changing management goals and may offer faster, albeit smaller, results. These studies show that combining carbon sequestration objectives and active adaptation strategies into synergistic policies can effectively sequester atmospheric carbon while simultaneously building local capacity for climate change adaptation, particularly within the developing world.

Forestry as a practice has a rich literature where it is understood that large-scale forest management activities such as harvest, replanting, thinning, and burning have significant impacts on the carbon balance [ 52 ]. Countries such as Indonesia and Costa Rica act as a carbon source because they are undergoing deforestation in service of palm oil plantations, while the eastern United States is acting as a carbon sink as it regenerates from deforestation that occurred in the nineteenth and twentieth centuries [ 53 ]. It is critical for nations, states, and communities to properly account for carbon emissions and sequestration if they seek to reach carbon-mitigation policy goals [e.g., 54 ]. Several papers found within our analysis report the effects of management activities on carbon storage, with examples from major forestry centers, including Australia [ 55 ], Canada [ 56 ], Nepal [ 7 ] and the United States [ 57 ]. Taken together, these papers demonstrate the need for quantifying carbon within a variety of forested ecosystems. While these reports are valuable for land managers as they inform carbon-smart strategies, ecosystem modelers need the rate of carbon sequestration and ecosystem recovery for their time-and-space sensitive analyses. Before they can be used to inform policy decisions, these models must be properly calibrated using field data derived from case studies. Some of the reviewed articles provide this information in detail [ 56 ] and others even provide a growth rate curve that is essential to most ecosystem models [ 55 ].

Carbon management within pastures is highly dependent upon SOM, which sequesters far more carbon than the above-ground fraction of the ecosystem [ 58 ]. Soil resilience is therefore critical to carbon sequestration success in the face of disturbances such as flood, erosion, and soil degradation [ 59 ]. Two papers studying pasture management of carbon report metrics such as biological diversity, SOM [ 59 ], carbon allocation, and macronutrients [ 60 ]. For agriculture practitioners, these metrics are of the utmost importance for management, and it is helpful that these papers display their results in terms that are familiar to farmers and scientists alike. These papers come from ecologically distinct, but regionally similar areas of Tibet [ 59 ] and Inner Mongolia [ 60 ], emphasizing the need for additional research in different geographic locations. Still, by framing their results with land management in mind, their findings are directly applicable to pasture managers who seek to maintain the quality of their soils while retaining carbon sequestered below ground.

This review also found a number of discussions of specialized agricultural practices and their impact on the carbon budget. Studies concerning the carbon sequestration benefits of small-scale farming practices in Ethiopia [ 15 ], intensive aquaculture in The Philippines [ 61 ], and cork production in Portugal [ 62 ] all provide useful quantifications of carbon as a result of management practices. The studies concerning farming and aquaculture appear to be highly applicable to other locales, however, some studies may be limited in their overall reach if their focus is highly localized in small industries with the relatively low potential for carbon sequestration [e.g., 62 ].

Taken together, these papers regarding carbon were less focused on framing their results to inform policy than the other papers within the review sample. Perhaps this is explained, in part, by papers that did discuss policy through interviews with land managers, which suggest that carbon sequestration land management practices have yet to be fully accepted within the policy world [ 50 , 51 ]. To improve this integration, future carbon sequestration studies should frame their results to appeal to land managers by including carbon sequestration potential, reproducible best management practices, quantified uncertainty, and economic analysis on return on investment or incentives.

For many biophysical researchers, implementing policy may be impossible, and advocating for policy change may be socially and professionally risky. There have even been recent directives from the executive branch of the United States government to limit scientist interaction with the media to ensure a unified public discourse [ 63 ]. Therefore, it would be understandable if federally-funded biophysical scientists are hesitant to recommend policy changes in the literature, or public media, as this could adversely affect the career of a federal land management employee. Still, there is ample opportunity for biophysical researchers to generate new information that can be useful in advising carbon-smart policies. As mentioned above, by quantifying and reporting the particular biophysical parameters that govern carbon in the ecosystem (along with other climate-sensitive compounds such as methane, aerosols, and pollutants) researchers are able to build a solid foundation for policy recommendations once this information gets to the appropriate decision-makers. Furthermore, by quantifying metrics such as the rate of carbon sequestration in forests [ 55 , 56 ] biophysical researchers can support higher-level research objectives, such as NASA’s global carbon monitoring system [ 64 ].

4.4 Opportunities and challenges for biophysical studies

The majority of non-human focused papers did not recommend any policies (20 out of 25). Of the five that did, policy recommendations were generally brief and vague. There was one non-human focused paper that gave specific policy recommendations, Boateng [ 65 ]; which is a single-authored paper by a civil engineer, that recommended policies to stabilize and protect the eastern coastline of Ghana. This example highlights the central role engineers play in the science-policy interface. Particularly in geographies where extreme climate-related events and sea level rise pose significant risks to infrastructure. Still, the strong majority of non-human focused papers did not make a policy recommendation.

4.5 The prominence of multidisciplinary teams

The call for a multidisciplinary approach to research is not new [ 66 , 67 ]. In climate change research, complex global problems warrant integrated scientific approaches to help understand the drivers and impacts from multiple perspectives [ 68 ]. Surprisingly, multidisciplinary author teams were not significantly associated with providing policy recommendations. This may be explained, in part, by the lack of academic integration found in multidisciplinary research, compared to research employing transdisciplinary methods that also include non-academic practitioners at multiple phases of the research [ 66 ].

In the case of this article, the author team was deliberately multidisciplinary involving geography, ecology, women’s studies, and public policy in an attempt to review the existing literature with a multidisciplinary perspective. This composition brought challenges while undergoing this project and required that the team spend hours synthesizing common definitions and learning how different scientific fields use different interpretations of similar concepts. These challenges are presumably akin to those encountered by authors of multidisciplinary papers included in our review, who may have found it difficult to reach a common understanding in research design and use of analytical methods. These challenges resonate with previous assessments of multidisciplinary work in sustainability science [ 69 ]. It is presumed that as research methods become more translatable across fields, and more non-academic stakeholders are involved in the research design process, multidisciplinary teams may increase their association with policy recommendations.

As mentioned above, the multidisciplinary composition of the team intentionally brought to the fore the known challenges of communicating climate science in different scientific disciplines. Even though two readers had to be in agreement on their interpretation and coding of a paper, some aspects of the paper remained reliant on each reviewer’s subjective judgment (e.g., understanding of national and subnational scope, number of ‘communities’ involved, and the extent a policy recommendation was concrete or vague).

Case study research that engages with local and community-defined geographies bares the ethical responsibility to capture and accurately represent those communities’ climate challenges. Future work may investigate the ethical components of community engagement, specifically the relationship between to the author’s national affiliation and the country where the study took place. Future work may also benefit from a closer look at the different methodological approaches that elicit climate change perceptions based on the urban-high-income country and rural-low-income country contexts. If case study data focusing on climate change impacts is to be incorporated into regional or global models, a detailed understanding of the comparison and contrast of those approaches will help researchers understand the implications of their methods.

This review used VOSviewer bibliometric and visualization software to cluster articles based on bibliometric similarities [ 21 ]. This method was a useful way to organize the articles into meaningful clusters, which facilitated the distribution of tasks among team members. It is possible that a larger number of clusters could have altered the review process, which is something future reviews that use this software may be able to explore. This review may serve as a guide for researchers who desire to engage in case study research on adaptation, recovery, and resilience to climate changes in both developing and developed countries and focused on human, natural, or coupled systems.

5 Conclusions

We conducted a systematic meta-review of 155 articles concerning climate change adaptation, resilience, and recovery from across the literature. Our aim was to characterize the aspects of case study research that are associated with providing policy recommendations. We found that policy recommendations were more robust, and significantly more likely, in papers that used methodologies focused on human subjects. Non-human, biophysical, studies make only 15% of our sample and they were not likely to provide policy recommendations. Methodological characteristics have a significant effect on the degree studies engaged with policy. Studies using quantitative methodologies were less likely to highlight the policy relevance of their research. In contrast, data collection and methodological approaches associated with human studies, such as the participatory research, focus groups, and the use of ethnographic techniques were all more likely to discuss policy. Within the human studies subset, we found that articles with case studies in rural areas were more likely to make policy recommendations than those exclusively focused on urban areas. Geographical characteristics, such as the country where the study takes place and the affiliation of the first author, also show significant associations with providing policy recommendations. Most notably, we found that studies conducted in Sub-Saharan Africa and studies first-authored by a person affiliated with that region were more likely to provide policy recommendations.

We also conducted a qualitative assessment of our sample in order to identify emerging themes in the literature and provide our own recommendations for researchers or decision-makers who wish to narrow the gap between science and policy. We emphasize the following conclusions based on the main themes within the literature: First, effective climate mitigation and adaptation are essentially local processes, therefore researchers must embrace the uniqueness of each locality at all stages of the research project. Second, trust in the governance institutions charged with addressing climate impacts is an important ingredient of effective participation and social learning [ 44 ]. Thus, large-scale models can rely on small-scale data validation approaches that are perceived to legitimately represent the uniqueness of the locality. Third, engagement of local populations and stakeholders is essential for effective and sustainable policy formation [ 7 ]. Fourth, studies that focus on biophysical parameters often lack policy recommendations, though the results of such studies provide essential supporting evidence for policymakers [ 55 , 56 , 64 ].

As climate change proceeds, developing countries will be hit the hardest [ 2 ]. By leveraging the big data era, researchers have an opportunity to inform policies that effectively mitigate the worst of these changes. Identifying the biophysical properties underlying, and the socio-political solutions to, these changes must be informed through case studies in a local context. Therefore, we must engage the locales of interest with care if researchers seek to improve their climate change prognosis and inform large-scale climate policy.

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Teodoro, J.D., O’Leary, D.S., Kerr, S.E. et al. The relevance of case studies in climate change research: a review of policy recommendations. SN Appl. Sci. 1 , 1197 (2019). https://doi.org/10.1007/s42452-019-1221-x

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Coping with Climate Change - Case studies on Climate Change Mitigation and Adaptation

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• Published: 06 August 2024

Doctors prepare for the “enormous health consequences” of climate change

• Sofia Moutinho 1  

Nature Medicine ( 2024 ) Cite this article

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Student doctors push for the health impacts of extreme weather to be taught in medical schools, as the carbon emissions from healthcare come under greater scrutiny.

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Sofia Moutinho

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Moutinho, S. Doctors prepare for the “enormous health consequences” of climate change. Nat Med (2024). https://doi.org/10.1038/s41591-024-03160-x

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Published : 06 August 2024

DOI : https://doi.org/10.1038/s41591-024-03160-x

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