Health promotion interventions to address climate change using a primary health care approach: a literature review

Abstract

Issue addressed This project explored the literature in which key concepts in primary health care and health promotion are overtly applied to the problem of climate change. This paper contains a discussion of the literature relevant to health promotion principles and intervention strategies for addressing climate change mitigation and adaptation in the primary health care sector. The concept of primary health care is that used by the World Health Organization, based on the Declaration of Alma Ata and often referred to as comprehensive primary health care to differentiate it from primary medical care. Methods This was a review of literature identified in electronic databases using two sets of search terms. Set A consisted of ‘climate change or global warming or greenhouse effect’ and set B consisted of 11 key concepts in primary health care and health promotion, for example community resilience, health promotion, social change, food security and economic development. Relevant literature was identified at the intersection of search term A with a term from set B. A search was completed for each set B term. Results This paper reports a discussion of major categories of health promotion interventions, namely health communication, community building and settings approaches and uses examples drawn from literature on community resilience and summer heat. These interventions are all applicable to the primary health care sector. Conclusion There is a small literature on health promotion interventions for climate change mitigation and adaptation but it is incomplete and scattered across many sources. An important area for further research is to link the logic of service provision in primary health care to the logic of mitigation and adaptation in a changing environment. Interventions that link the logic must also link diverse services to provide coherent action on local and domestic scales, the scales at which primary health care acts. Another research gap is in regard to institutional change in the primary health care sector. How do the patterns of knowledge, practice and values need to change in the array of organisations that make up comprehensive primary health care? So what? This literature review can support primary health care agencies to design interventions to address climate change using health communication, community building and settings approaches in the knowledge that there is peer‐reviewed literature to support such initiatives. It also identifies two areas of research that would support institutional adaptation within comprehensive primary health care to enable it to fulfil its role in the societal response to climate change.

Systematic review approaches for climate change adaptation research

“…Reflecting the tradition of systematic reviews in the health sciences, health-related adaptation was the focus of six articles (Walker et al 2011;Hosking and Campbell-Lendrum 2012;Bouzid et al 2013;Cheng and Berry 2013;Poutiainen et al 2013;Toloo et al 2013). The most dominant adaptation focus within which systematic reviews have penetrated has been reviewing lessons from, and trends in, adaptation governance (Hardee and Mutunga 2010;Berrang-Ford et al 2011;Ford et al 2011;Pearce et al 2011;Ford et al 2012a, b;Larsen et al 2012;Murtinho and Hayes 2012;Biesbroek et al 2013;Kamau and Mwaura 2013;Vink et al 2013).…”

“…Consideration of context, processes, and mechanisms of causality may require more time commitment per document than extraction of key estimates or discrete items of information. Many realist or in-depth reviews, for example, are conducted using fewer than 50 articles, often 30-40 documents (Bouzid et al 2013;Cheng and Berry 2013;Kajan and Saarinen 2013;Linnenluecke et al 2013), and even in-depth qualitative systematic analyses with as few as 15-20 articles (Walker et al 2011;Toloo et al 2013). Research has shown that systematic review of complex and heterogeneous literature bases cannot rely solely on strict keyword searches (Greenhalgh and Peacock 2005), and this is likely to apply to many complex adaptation policy and practice questions.…”

“…Vink et al (2013), for example, frame their review of adaptation governance using theoretical constructs of knowledge and power, with their theoretical framework explicitly described in the methods section and results summarized around these concepts. The predominant theories guiding the literature we reviewed included adaptation and vulnerability theory (e.g., Ford et al 2012b), statistical theory in the case of meta-analyses (Bowler et al 2010;Shepard et al 2011) and public health (Walker et al 2011;Hosking and Campbell-Lendrum 2012;Bouzid et al 2013;Cheng and Berry 2013;Toloo et al 2013).…”

Climate change, human health, and epidemiological transition

“…A few authors have begun to envision the changes that the health care system will need to undertake in response to climate change (Blashki et al, 2007; Ebi, 2011; Parker, 2011; Podein and Hernke, 2010; Richardson et al, 2009; Rosenblatt, 2005; Walker et al, 2011). Several of these have to do with infrastructure and technology.…”

Let's not forget climate change in the food insecurity conversation: why the homeless are most vulnerable

“…11 However, literature on climate change and health promotion practice remains incomplete, with research gaps in this area clearly evident. 12 It is imperative that Australia's future efforts to mitigate and adapt to climate change continue, with priority given to investment in programs and policies to address food insecurity and increase access to healthy foods for all vulnerable populations.…”