Wright Caradee Y, Naidoo Natasha, Anand Nalini, Kapwata Thandi, Webster Candice
Environment and Health Research Unit, South African Medical Research Council, SAMRC, 1 Soutpansberg Road, Pretoria, South Africa.
Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa.
BMC Public Health. 2025 Jul 2;25(1):2247. doi: 10.1186/s12889-025-23358-z.
Climate change is a grave threat to human health and wellbeing. Adaptation is one mechanism (the other is mitigation) by which we can intervene to increase adaptive capacity and preparedness to protect people. Adaptation interventions (evidence-based adjustment of programs/practices that lead to improved response and resilience to climate change) are being conducted around the world. However, existing conceptual frameworks to assess the effectiveness of these interventions, especially with respect to improving health outcomes and systems are not readily applied in areas where these are needed. This is applicable to both interventions intended to improve health as well as those without a health-focus but which may have health co-benefits. To address this gap, we conducted a multi-vocal review comprised of a scoping review and key informant interviews, which informed the development of an initial assessment framework. We included 21 academic articles and 12 reports (from the grey literature) for data collation and synthesis. Of the 21 articles analyzed, only seven presented primary evidence of health improvement outcomes, such as reduction in neo-natal care unit admissions was partially attributed to moving the maternity ward to the cooler, lower floor of the hospital. From the 10 interviewees, we learnt that most existing tools to assess the effectiveness of adaptation are for country or regional (several countries sharing borders within a large section of a continent) scales (e.g., Notre Dame Global Adaptation Initiative Index) and none focused specifically on health / health co-benefits. From these learnings together with a guiding concept, we crafted the first iteration of an assessment framework, SCALE-up, comprising six steps that prompt a researcher to consider the effectiveness of their adaptation intervention at a project-scale, including from a health benefit perspective. We apply the framework in four scenarios: hot days-heat; floods; droughts; and vector-borne diseases, to illustrate how the framework may help guide the researcher to think about effectiveness from project proposal stage. The next steps are to implement and pilot the framework in the four proposed scenarios and refine the framework.
气候变化对人类健康和福祉构成严重威胁。适应是一种干预机制（另一种是缓解），通过它我们可以进行干预，以提高适应能力和防范能力来保护人们。世界各地都在开展适应干预措施（基于证据对项目/实践进行调整，从而提高对气候变化的应对能力和恢复力）。然而，现有的评估这些干预措施有效性的概念框架，尤其是在改善健康结果和卫生系统方面，在需要的地区却难以应用。这适用于旨在改善健康的干预措施，以及那些虽不以健康为重点但可能带来健康协同效益的干预措施。为了填补这一空白，我们进行了一项多方参与的综述，包括范围界定综述和关键信息人访谈，这些为初步评估框架的制定提供了信息。我们纳入了21篇学术文章和12份（灰色文献中的）报告进行数据整理和综合分析。在分析的21篇文章中，只有7篇提供了健康改善结果的主要证据，例如新生儿护理病房入院人数的减少部分归因于将产科病房迁至医院较凉爽的较低楼层。从10名受访者那里，我们了解到，大多数现有的评估适应有效性的工具是针对国家或区域（一个大洲大片区域内几个接壤国家）层面的（例如圣母大学全球适应倡议指数），没有一个专门关注健康/健康协同效益。基于这些经验教训以及一个指导理念，我们精心设计了评估框架SCALE-up的第一版，它包含六个步骤，促使研究人员在项目层面考虑其适应干预措施的有效性，包括从健康效益的角度。我们将该框架应用于四种情景：炎热天气 - 高温；洪水；干旱；以及媒介传播疾病，以说明该框架如何在项目提案阶段帮助指导研究人员思考有效性。接下来的步骤是在这四种提议的情景中实施并试点该框架，并对框架进行完善。
