Out of the frying pan into the fire? Urban penalty of the poor and multiple barriers to climate change adaptation in Cambodia and Tanzania

Coastal cities face significant impacts from climate change, with potentially serious consequences for human health especially for the urban poor and other vulnerable groups. As part of a larger study in the Indian Ocean world, this paper assesses the joint effect of urbanicity and wealth status on reported number of barriers to climate change adaptation. Negative binomial regression models were fitted to cross-sectional survey data on 1823 and 1253 individuals in coastal Cambodia and Tanzania, respectively. In the pooled multivariate analysis, there exists an urban poor penalty regarding the total number of reported barriers to climate change adaptation. This relationship persists even when biosocial, socio-cultural, and contextual factors are taken into account. Also, there are differentials in self-ratings on health status by the rural poor, rural non-poor; urban poor, and urban non-poor. Only 20 % of urban poor and rural poor individuals rated their health status as either very good or excellent compared with 25 and 33 % of rural non-poor and urban non-poor individuals, respectively. Quite unexpectedly, individuals who considered their health status as either fair or good were more likely to report higher number of barriers to climate change adaptation compared with those with poor self-rated health. Individuals in only one age category (more than 65 years) in Cambodia and five age categories (26-30, 31-34, 35-40, 41-45, and 56-60 years) in Tanzania had lower incidence rates of reporting higher number of barriers to climate change adaptation compared with 18-25-year olds. Compared with female-centered households, extended family in Cambodia and male-centered households in Tanzania had lower incidence rates of reporting higher number of barriers to adaptation. Although in Tanzania, there was no relationship between relative household quality and number of barriers to adaptation, in Cambodia, individuals who rated their household quality as better had lower incidence rates of reporting higher number of barriers to adaptation compared with those who rated their household quality as worst in the neighborhood. A policy implication of this study is that sustaining and improving human settlements and health in the face of ongoing global climate change should become an important lens for coastal cities in both countries.