Mousavi Arefeh, Ardalan Ali, Takian Amirhossein, Naddafi Kazem, Mesdaghinia Alireza
Social Determinants of Health Research Center (SDHRC), Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Health in Disasters and Emergencies, Isfahan University of Medical Sciences, Isfahan, Iran.
BMC Public Health. 2025 Mar 6;25(1):893. doi: 10.1186/s12889-025-22029-3.
Ensuring public health is crucial in any policy debate on climate change. Paris Agreement on Climate Change is a global contract through which countries have committed themselves to a public health treaty. This study was conducted to identify the challenges that lie ahead for policymakers and provide an evidence-informed framework for policymaking to increase the resilience of Iran's health system to health consequences of climate change.
A qualitative study using semi-structured interviews was conducted with 25 experts. Purposeful and snowball sampling techniques were used for data gathering. Thematic content analysis was conducted with a deductive-inductive approach. Leichter's model, the stage's heuristic framework, and Kingdon's models were used for analyzing the context and process analysis respectively. MAXQDA 20 software was used.
A total of four main themes and twelve sub-themes were identified concerning various contextual factors, including political, economic, international, and cultural/social challenges. The primary obstacles to implementing adaptation measures were found to be political considerations, economic sanctions, and the low-risk perception held by both the public and policymakers. Additionally, fifteen themes and forty-eight sub-themes related to the process were identified across several areas: agenda setting, which includes the problem stream, policy stream, and politics stream; policy formulation, encompassing governmental and managerial aspects, research, evidence-informed policymaking, and the role of Non-Governmental Organizations; policy implementation, which covers early warning systems, education, inter-sectoral coordination, architecture and engineering, and integrated databases; and policy evaluation, focusing on inadequate evaluation methods.
The study identifies key challenges in implementing the Paris Agreement within Iran's health system, categorized into four main themes: political, economic, international, and cultural/social. Political issues stem from the politicization of climate change and national security concerns. Economically, reliance on oil and sanctions hinder progress, while high technology costs strain resources. Internationally, a lack of binding commitments and technological sanctions impede efforts. Culturally, low public awareness and inadequate inter-organizational collaboration limit engagement. The study emphasizes the need for cohesive policies, enhanced public education, and improved coordination among sectors to effectively address climate change impacts on health.
在任何关于气候变化的政策辩论中，确保公众健康都至关重要。《巴黎气候变化协定》是一项全球契约，各国通过该契约致力于达成一项公共卫生条约。开展本研究旨在确定政策制定者面临的挑战，并提供一个基于证据的政策制定框架，以增强伊朗卫生系统应对气候变化对健康影响的复原力。
对25名专家进行了一项采用半结构化访谈的定性研究。采用目的抽样和滚雪球抽样技术收集数据。采用演绎-归纳法进行主题内容分析。分别使用莱希特模型、阶段启发式框架和金登模型进行背景分析和过程分析。使用MAXQDA 20软件。
共确定了四个主要主题和十二个次主题，涉及各种背景因素，包括政治、经济、国际和文化/社会挑战。实施适应措施的主要障碍包括政治考量、经济制裁以及公众和政策制定者的低风险认知。此外，在几个领域确定了与过程相关的十五个主题和四十八个次主题：议程设定，包括问题流、政策流和政治流；政策制定，涵盖政府和管理方面、研究、基于证据的政策制定以及非政府组织的作用；政策实施，包括预警系统、教育、部门间协调、建筑与工程以及综合数据库；以及政策评估，重点关注评估方法不足。
该研究确定了伊朗卫生系统在实施《巴黎协定》方面的关键挑战，分为四个主要主题：政治、经济、国际和文化/社会。政治问题源于气候变化的政治化和国家安全担忧。在经济方面，对石油的依赖和制裁阻碍了进展，而高科技成本使资源紧张。在国际上，缺乏具有约束力的承诺和技术制裁阻碍了努力。在文化方面，公众意识淡薄和组织间协作不足限制了参与度。该研究强调需要制定连贯的政策、加强公众教育并改善部门间协调，以有效应对气候变化对健康的影响。
