Developing a climate change inequality health impact assessment for health services.

OBJECTIVES: To develop a Climate Change Inequality Health Impact Assessment (CCIHIA) framework for health services; to provide a systematic process for assessing potential unequal health impacts of climate change on vulnerable and marginalised populations and places; to support effective planning to address these impacts; and to develop contextually appropriate local strategies. Type of program: A collaborative interdisciplinary scoping research project involving two universities and two local health districts (LHDs) in New South Wales (NSW) to develop a CCIHIA framework. This work builds upon the health impact assessment (HIA) approach, which systematically assesses proposals' potential health and equity impacts by involving stakeholders in developing responses. METHODS: The project involved four main activities: understanding stakeholder requirements; conceptualising climate change vulnerability; considering the role of health services; and integrating findings into a conceptual framework. RESULTS: Stakeholders identified key functions that should be addressed across the framing, process and utility of the CCIHIA framework. The resulting conceptual framework outlines contexts and social stratification, the differential impacts of climate change (including factors influencing unequal impacts) and the health system's position, and also identifies key potential points of intervention. LESSONS LEARNT: The challenge of addressing the complexity of factors and resulting health impacts is reflected within the CCIHIA framework. While there are many intervention points within this framework for health services to address, many factors influencing unequal impacts are created outside the health sector's direct control. The framework's development process reflected the focus on collaboration and the interdisciplinary nature of climate change response. Ultimately, the CCIHIA framework is an assessment tool and an approach for prioritising inclusive, cross-cutting, multisector working, and problem-solving.

Built environment interventions for human and planetary health: integrating health in climate change adaptation and mitigation.

OBJECTIVES: Human-generated climate change is causing adverse health effects through multiple direct pathways (e.g. heatwaves, sea-level rise, storm frequency and intensity) and indirect pathways (e.g. food and water insecurity, social instability). Although the health system has a key role to play in addressing these health effects, so too do those professions tasked with the development of the built environment (urban and regional planners, urban designers, landscapers and architects), through improvements to buildings, streets, neighbourhoods, suburbs and cities. This article reports on the ways in which urban planning and design, and architectural interventions, can address the health effects of climate change; and the scope of climate change adaptation and mitigation approaches being implemented by the built environment professions. Type of program or service: Built environment adaptations and mitigations and their connections to the ways in which urban planning, urban design and architectural practices are addressing the health effects of climate change. METHODS: Our reflections draw on the findings of a recent review of existing health and planning literature. First, we explore the ways in which 'adaptation' and 'mitigation' relate to the notion of human and planetary health. We then outline the broad scope of adaptation and mitigation interventions being envisioned, and in some instances actioned, by built environment professionals. RESULTS: Analysis of the review's findings reveals that adaptations developed by built environment professions predominantly focus on protecting human health and wellbeing from the effects of climate change. In contrast, built environment mitigations address climate change by embracing a deeper understanding of the co-benefits inherent in the interconnectedness of human health and wellbeing and the health of the ecosystem on which it depends. In the final section, we highlight the ethical transition that these approaches demand of built environment professions. LESSONS LEARNT: Built environment interventions must move beyond simple ecological sustainability to encouraging ways of life that are healthy for both humans and the planet. There are key challenges facing this new approach.