Piloting a city health adaptation typology with data from climate-engaged cities: Toward identification of an urban health adaptation gap

Climate change has important population health impacts, and cities are often on the frontlines. However, health is reported to be less active in climate adaptation than other sectors. To contribute to better understanding urban health adaptation efforts and identifying gaps we developed a City Climate Health Adaptation Typology and tested it with adaptation actions of 106 large world cities (population > 1 million) reported to a major publiclyavailable adaptation database. We found two-thirds of actions of these ?active adapter? cities were healthassociated. Half were health information activities (e.g., hazard mapping, early warnings); and nearly onethird addressed climate-relevant health determinants in the urban built environment (e.g., green space). Forty percent of cities were in low- or middle-income countries. Our proposed typology provides a systematic framework for monitoring and comparing city health adaptation actions. Reported city actions are suggestive of increasing depth and breadth of urban health-associated adaptation. However, even among these adaptationengaged cities, a health adaptation gap was apparent in key climate health services (e.g., mental health), and in climate-related public health governance and capacity building. The COVID-19 pandemic has demonstrated pressing need for strong public health institutions. We recommend better integration of public health agencies into local climate action planning, enhanced modes of collaboration between health and non-health agencies and with non-governmental actors, and strengthening of city public health adaptive capacity including through networking.

Automated summary

Research found that the majority of "active adapter" cities' actions are related to health, with half being health information activities and nearly one-third addressing climate-relevant health determinants in the urban built environment. 40% of the cities were in low- or middle-income countries. The proposed typology provides a systematic framework for monitoring and comparing city health adaptation actions.