The Effectiveness of Public Health Interventions to Reduce the Health Impact of Climate Change: A Systematic Review of Systematic Reviews

Abstract

BackgroundClimate change is likely to be one of the most important threats to public health in the coming years. Yet despite the large number of papers considering the health impact of climate change, few have considered what public health interventions may be of most value in reducing the disease burden. We aimed to evaluate the effectiveness of public health interventions to reduce the disease burden of high priority climate sensitive diseases.Methods and FindingsFor each disease, we performed a systematic search with no restriction on date or language of publication on Medline, Web of Knowledge, Cochrane CENTRAL and SCOPUS up to December 2010 to identify systematic reviews of public health interventions. We retrieved some 3176 records of which 85 full papers were assessed and 33 included in the review. The included papers investigated the effect of public health interventions on various outcome measures. All interventions were GRADE assessed to determine the strength of evidence. In addition we developed a systematic review quality score. The interventions included environmental interventions to control vectors, chemoprophylaxis, immunization, household and community water treatment, greening cities and community advice. For most reviews, GRADE showed low quality of evidence because of poor study design and high heterogeneity. Also for some key areas such as floods, droughts and other weather extremes, there are no adequate systematic reviews of potential public health interventions.ConclusionIn conclusion, we found the evidence base to be mostly weak for environmental interventions that could have the most value in a warmer world. Nevertheless, such interventions should not be dismissed. Future research on public health interventions for climate change adaptation needs to be concerned about quality in study design and should address the gap for floods, droughts and other extreme weather events that pose a risk to health.

Beyond Climate Change and Health: Integrating Broader Environmental Change and Natural Environments for Public Health Protection and Promotion in the UK

“…This includes improved methods for the assessment of the health implications of decisions in other sectors (such as in the energy and transport sectors and in the water, food and agriculture sectors), and the improved integration of climate change mitigation, adaptation and health through "settings-based" research; • improve decision-support, for example, research to improve vulnerability and adaptation assessments, operational predictions, and the understanding of decision-making processes; • improve the public's understanding of these issues, and into what interventions and mitigation strategies will be deemed acceptable to which constituencies; • estimate the costs of protecting health from the effects of climate change, including the characterisation of harmonized methods to estimate costs and benefits, the assessment of the health costs of inaction and the costs of adaptation, and improved economic assessment of the health co-benefits of climate and other environmental change mitigation [25,[130][131][132][133].…”

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).…”

European policy responses to climate change: progress on mainstreaming emissions reduction and adaptation

“…An appraisal was conducted of the effectiveness of public health interventions directed at the climate-sensitive diseases through a systematic review of systematic reviews (Bouzid et al 2013). No reviews were found for nine of 17 of the high-priority climate-sensitive diseases.…”