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CLIMATE AND HEALTH RESEARCH GAPS

The multi-phase process (informational interviews, review of existing literature, and feedback from interested stakeholders through a survey of meeting attendees) generated a wide range of topics related to the intersection of environmental factors, climate change, and human health. These topics were categorized into four overarching domains (see Table 1-1). In developing these domains, existing frameworks on climate change and health were reviewed, including the Lancet Countdown’s monitoring framework on health impacts of climate change (Romanello et al. 2023), the World Health Organization’s (WHO’s) operational framework for building climate-resilient health systems (Shumake-Guillemot et al. 2015), the United States Global Change Research Program’s primary exposure pathways by which climate change affects health (USGCRP 2016), the National Institutes of Health (NIH)-wide Climate Change and Health Initiative’s strategic framework (NIH 2022), and the InterAcademy Partnership’s Global Synthesis Report (IAP 2022).

The four domains include:

• Domain 1: Climate Impacts on Health and Related Economic Outcomes in the United States: This domain explores the direct and indirect impacts of climate and health, including the spread of water-borne diseases, food insecurity, malnutrition, and respiratory illnesses. Additionally, it considers the cross-generational impacts of climate change and the heightened vulnerability of high-risk populations. Moreover, this domain highlights the need for studying disease mechanisms at the biochemical, molecular (epigenetic), cellular and tissue levels, as well as adopting a One Health approach—a collaborative framework that recognizes the interconnections between human, animal, and environmental health—to understand and address the multi-faceted impacts of climate change across these systems.

• Domain 2: Crosscutting Strategies to Support Climate-Health Resilience and Infrastructure: Adaptation, Mitigation, and Equity in Action: This domain focuses on the strategies for mitigating and adapting to the health impacts of climate change. It includes research on reducing greenhouse gas emissions, developing adaptive health infrastructure, and fostering collaboration and community engagement to build resilience. This domain also includes consideration of the burden climate change places on critical infrastructures that support human health, including water, sanitation, food, and agriculture systems. It also emphasizes the importance of addressing the needs of vulnerable populations—such as the older adults, children, and women—by incorporating health equity considerations and addressing the social drivers that exacerbate climate-related health disparities. Special attention is given to Indigenous health and the integration of traditional knowledge.
• Domain 3: Research and Technology Infrastructure and Capacity Building: This domain addresses the essential research and technological needs required to support climate and health initiatives. It highlights the importance of robust data systems, the development of new technologies, and the expansion of workforce capacity to address climate-related health challenges. The domain also emphasizes the need for sustained funding to ensure the long-term success of research efforts and the implementation of innovative solutions.
• Domain 4: Policy and Public Communication, Education, and Engagement: This domain emphasizes the critical roles of public policy and public engagement and education in driving changes in climate and health. First, examining the role of policy frameworks and governance structures is essential for facilitating systems changes that will ultimately deliver positive changes at the intersection of climate and health outcomes. This domain also emphasizes the importance of policy research and developing effective methods for communicating with and educating policymakers at local, state, national, and international levels to ensure that climate and health research informs actionable and equitable policy decisions. Second, public communication, education, and engagement are necessary to facilitate public awareness, encourage behavior change, empower communities to take action, and, ultimately, to influence changes in policy and governance. Public engagement is envisioned as a bi-directional process, where researchers not only disseminate knowledge but also learn from the lived experiences, insights, and concerns of the public. This collaborative approach fosters a deeper understanding of science and strengthens community resilience. By valuing and incorporating public input, this domain aims to create more effective, inclusive, and culturally relevant climate and health interventions.

TABLE 1-1 | Overarching Domains and Research Gaps

DOMAIN 1: CLIMATE IMPACTS ON HEALTH AND RELATED ECONOMIC OUTCOMES IN THE UNITED STATES

As climate change accelerates, its effects on health-supporting infrastructure and population health outcomes become increasingly severe and complex. Rising temperatures, extreme weather events, and shifting environmental patterns pose direct and indirect health risks that disproportionately affect communities living in vulnerable conditions. This section explores the various ways in which climate change influences health outcomes in the United States, focusing on the pathways through which temperature extremes, compromised air and water quality, and food insecurity exacerbate existing health challenges. The interplay between climate change and public health underscores the urgent need for adaptive infrastructure, resilient health care systems, and targeted research to mitigate the impact on at-risk populations. Addressing these challenges is essential to protect public health, advance health equity, and develop sustainable strategies for a climate-resilient future.

Heat-Related Illnesses and Mortality

Climate change has already raised overall temperature distribution and contribute to an increase in the frequency of extreme heat events. Heat waves are becoming more frequent and intense in the United States, leading to a rise in heat-related illnesses and mortality. Heat-related deaths have been steadily increasing in the United States, with approximately 2,302 deaths occurring in 2023 (CDC 2023). These impacts are expected to worsen as temperatures continue to rise. There are several pathways through which heat impacts health. For example, extreme heat is associated with increased hospital admissions for respiratory and kidney-related conditions among older adults (Bobb et al. 2014; Gronlund et al. 2014). Young children and pregnant women face heightened risks from heat exposure. For children, heat stress can lead to dehydration, heat exhaustion, and, in severe cases, heat stroke, given their limited ability to regulate body temperature. Pregnant women exposed to high heat levels are at an increased risk of adverse pregnancy outcomes, including preterm birth and low birth weight (Samuels et al. 2022; Schapiro et al. 2024). Increased temperatures have been associated with increased overall risk of cardiovascular disease-related mortality (Khatana et al. 2022; Liu et al. 2022). High levels of air pollution further amplify the adverse effect of increased temperature on cardiovascular disease-related mortality (Rahman et al. 2022; Rai et al. 2023). Heat stress can exacerbate chronic conditions and lead to

heat exhaustion and heat stroke, which can be fatal if not promptly treated (WHO 2021). Higher temperatures are also linked to disruptions in sleep, which can exacerbate adverse health outcomes, including cardiac, neurological conditions, and mental health impacts (Rifkin et al. 2018).

Health Impacts of Extreme Weather Events (e.g., Hurricanes, Floods, Droughts)

Climate change is intensifying the frequency and severity of extreme weather events such as hurricanes, floods, and droughts in the United States, significantly affecting public health (USGCRP 2016). Extreme weather events pose immediate and longer-term threats to human health and well-being. Immediate health effects include injuries, fatalities, and displacement. For children, displacement from extreme weather events disrupts school attendance and performance, impacting educational outcomes, long-term development, and mental health, with increased risks of anxiety and post-traumatic stress disorder (PTSD) (Lai and La Greca 2020). They can also disrupt the physical and social infrastructure people and communities rely on to stay safe and healthy and increase exposure to other harmful environmental conditions. For instance, flooding, exacerbated by rising sea levels and intense rainfall, results in drowning, injuries, and waterborne diseases. The contamination of drinking water with pathogens and hazardous chemicals poses significant health risks. Floods also disrupt health care services, complicating the treatment of chronic diseases and injuries (Ebi et al. 2021). Recent studies further reveal that exposure to floods is associated with increased non-accidental causes of death, including cardiovascular, respiratory, and mental health disorders (Ban et al. 2023).

Water-Borne Diseases

Climate change is having profound effects on water resources and sanitation in the United States, significantly impacting public health. Increased temperatures, altered precipitation patterns, and more frequent extreme weather events such as floods and droughts are exacerbating existing challenges and introducing new ones. Increased flooding can contaminate water supplies with pathogens, leading to waterborne diseases such as cholera and leptospirosis. Droughts reduce water availability, exacerbating issues related to sanitation and hygiene.

Furthermore, climate change is significantly affecting the prevalence and distribution of waterborne diseases in the United States. These diseases, caused by pathogens such as bacteria, viruses, and parasites, lead to gastrointestinal illnesses,

respiratory infections, and other health issues. Climate-related factors such as rising temperatures, altered precipitation patterns, and increased frequency of extreme weather events are key drivers of these changes (Semenza et al. 2023).

Rising temperatures foster the proliferation of pathogens in water bodies. For instance, warmer waters can enhance the growth of Vibrio bacteria, leading to illnesses such as cholera and vibriosis (Vezzulli 2022). Changes in precipitation patterns and more frequent extreme weather events, such as heavy rainfall and hurricanes, can lead to water contamination. Heavy rains and flooding often overwhelm sewage systems and water treatment plants, causing runoff of pollutants, including pathogens, into water bodies. Drought conditions reduce water availability, concentrating pollutants and pathogens in remaining water sources. During droughts, communities may resort to alternative, often unsafe, water sources, raising the risk of pathogen exposure (Stanke et al. 2013).

Air Quality and Climate Health

Climate change significantly impacts air quality, leading to a range of adverse health effects. The interplay between rising temperatures, altered weather patterns, and increased frequency of wildfires contributes to worsening air pollution, affecting millions of Americans.

Disruptions in weather patterns influence air quality by increasing and dispersing air pollutants, such as ground-level ozone, fine particulates, wildfire smoke, and dust. Changes in seasonal weather also affect the production, distribution, and severity of airborne allergens (Tran et al. 2023). Although primarily affecting outdoor air quality, these pollutants and allergens can also degrade indoor air quality by infiltrating homes, schools, and buildings.

Air quality deterioration due to climate change is linked to increased respiratory and cardiovascular risks. Particulate matter, ozone, and other pollutants exacerbate conditions such as asthma, chronic obstructive pulmonary disease, and heart disease. Studies have shown a correlation between high pollution days and increased hospital admissions for respiratory and cardiovascular issues (Sun et al. 2024; Wei et al. 2024). Children are particularly vulnerable to air pollution, which is linked to higher rates of asthma, reduced lung function, and even neurodevelopmental delays (Johnson et al. 2021). Pregnant women exposed to particulate pollutants have an elevated risk of preterm birth and delivering infants with low birth weight (Bekkar et al. 2020).

Vector-Borne Diseases (e.g., Malaria, Dengue, Lyme Disease)

Changes in temperature, precipitation patterns, and humidity influence the habitats, life cycles, and behavior of vectors such as mosquitoes and ticks, thereby altering disease dynamics. These changes can expand the range of these vectors, increasing disease incidence in previously unaffected areas.

The prevalence of vector-borne diseases has increased in recent decades and the prevalences of diseases such as malaria, dengue, Lyme disease, and West Nile virus infection are expected to further increase during the decades if measures are not taken to adapt and strengthen control strategies (Beard et al. 2016; IPCC 2023).

For example, Lyme disease, caused by the bacterium Borrelia burgdorferi and transmitted by black-legged ticks, has seen a noticeable increase in cases and geographical spread. Warmer temperatures and shorter winters have expanded the tick’s habitat northward and extended the transmission season (Bouchard et al. 2019). Increased suburban development has also brought people closer to tick habitats, raising the risk of exposure. West Nile virus, primarily spread by Culex mosquitoes, has also been affected by climate change (Wang et al. 2024). Warmer temperatures accelerate mosquito development and viral replication, while altered precipitation patterns create favorable breeding conditions. Periods of drought can concentrate mosquito populations in standing water, increasing transmission risk. Outbreaks have been more frequent and widespread, with significant public health implications.

Food Security and Nutrition

Climate change threatens food security and nutrition by impacting agricultural productivity, food distribution, and food prices (USDA 2015). Extreme weather events, changing precipitation patterns, and increased temperatures can reduce crop yields, affecting the availability and quality of food. This, in turn, can lead to malnutrition and related health issues.

Altered climate conditions affect the productivity of staple crops like wheat, corn, and soybeans (Jägermeyr 2021). Higher temperatures and changing precipitation patterns can reduce crop yields, leading to lower food availability and higher prices. Extreme weather events, such as droughts, can devastate agricultural production, causing significant losses and threatening food security. Additionally, climate change can also affect the nutritional quality of food. Increased levels of carbon dioxide can reduce the concentrations of essential nutrients in crops, such as protein, zinc, and iron (Myers et al. 2015; Smith and Myers 2018). This decline in nutritional quality

can lead to deficiencies in essential nutrients, impacting overall health, particularly in populations living in vulnerable conditions. Furthermore, rising temperatures and humidity create favorable conditions for the spread of plant pathogens, increasing crop vulnerability (Singh et al. 2023). This pressure can lead to greater pesticide use, which carries health risks for farmworkers and surrounding communities and has broader implications for environmental and human health (Ferguson et al. 2019).

Mental Health and Well-Being

Climate change significantly impacts mental health, manifesting in various ways (Hough and Counts 2023). The psychological effects are driven by direct exposure to extreme weather events, chronic environmental changes, and the broader societal and economic disruptions that follow.

Natural disasters such as hurricanes, wildfires, floods, and droughts can cause immediate psychological distress. The trauma from these events includes anxiety, depression, PTSD, and other stress-related conditions. The immediate aftermath can also lead to long-term mental health conditions, especially if recovery is slow or resources are scarce. Prolonged exposure to extreme heat is linked to increased aggression, violence, and higher rates of suicide. In addition, both short-term and daily exposure to heat—ranging from mild to extreme—can lead to increased emergency room visits for a variety of mental health conditions, including substance abuse, mood and anxiety disorders, and schizophrenia (Yoo et al. 2021). Heat stress can exacerbate pre-existing mental health conditions, and the discomfort and disruption caused by heatwaves can lead to significant psychological strain (Li et al. 2020).

Additionally, the long-term uncertainty associated with climate change contributes to chronic stress and mental health disorders. Gradual changes, such as rising sea levels, desertification, and biodiversity loss, lead to community displacement and loss of livelihoods, particularly in agriculture-dependent regions. These slow-onset changes cause chronic stress and anxiety, especially in populations with strong ties to the land and environment (Comtesse et al. 2021).

Cross-Generational Impacts of Climate Change on Health

Emerging research suggests that climate change can have cross-generational impacts via epigenetic effects on health, altering gene expression without changing the DNA sequence (Breton et al. 2021; Mendola and Ha 2022). These changes can be induced by environmental stressors such as temperature fluctuations, pollution, and nutrition changes, potentially leading to long-term health impacts

that may be passed to future generations. For instance, heat stress can influence the expression of genes related to inflammation, stress response, and metabolic pathways, potentially impacting long-term health (Bouchama et al. 2017; Cantet et al. 2021). Increased levels of air pollutants such as particulate matter (PM_2.5), ozone, and heavy metals, which are exacerbated by climate change, have been linked to epigenetic alterations (Gavito-Covarrubias et al. 2024; Mukherjee et al. 2021). These changes can lead to respiratory diseases, cardiovascular conditions, and other chronic health issues (Cardenas et al. 2023).

High-Risk Populations Living at the Intersection of Vulnerable Conditions and Climate Change

High-risk populations, particularly those living at the intersection of vulnerable conditions and climate change, face disproportionately severe health impacts as the climate change and health crisis intensifies. These populations include older adults; children; adolescents; individuals with pre-existing health conditions; those experiencing poverty; those without adequate access to health care; and individuals identifying as Black or African American; American Indian or Alaska Native; Asian; Native Hawaiian or Other Pacific Islander, and/or Hispanic or Latino (EPA 2021). Socioeconomically disadvantaged communities often face higher exposure to environmental stressors due to factors such as poor housing, proximity to pollution sources, and limited access to health care, increasing their risk of adverse epigenetic changes. Tools like the Maryland Environmental Justice Screening Tool (MD EJSCREEN) can help identify these communities by mapping areas with elevated environmental, health, and socioeconomic burdens. Using geographic information system mapping, MD EJSCREEN works by integrating data on environmental contamination, socioeconomic indicators, and health disparities into a GIS-based platform, enabling users to visualize and assess environmental justice concerns across Maryland census tracts. Such tools are essential for guiding targeted interventions and policies to reduce health inequities in the face of climate change.

For example, children and adolescents are at heightened risk for mental health conditions due to climate change, experiencing unique challenges like solastalgia—a form of place-based distress caused by environmental change—and climate anxiety, which can contribute to higher rates of anxiety and depression (Gislason et al. 2021). Additionally, older adults, children, and individuals with pre-existing health conditions—including those on medications affecting thermoregulation (e.g., stimulants for narcolepsy or other medications impacting heat tolerance)—are at higher risk of heat-related illnesses and mortality. Populations at heightened risk

from extreme heat exposure also include those who are experiencing homelessness, are emergency responders, are athletes, and/or work outdoors, as well as groups who face high socioeconomic burden and/or additional barriers to accessing cooling or health care (e.g., are low income and/or have one or more disabilities) (EPA 2021). Urban “heat islands,” characterized by dense infrastructure and limited green spaces, exacerbate heat-related health risks for urban residents (Tong et al. 2021). Historical redlining practices have left lasting impacts on heat vulnerability in the United States, with studies showing that communities previously “redlined” are more likely to face increased heat exposure due to limited access to cooling infrastructure and green spaces. Contemporary assessments, such as the Climate and Economic Justice Screening Tool, reveal that these historically disadvantaged areas continue to experience higher vulnerability to extreme heat (Manware et al. 2022). For example, an analysis of Richmond, Virginia, reveals significant thermal inequity rooted in these historical zoning policies. Areas with high proportions of Black and low-income residents, such as Richmond’s East End, experience higher urban heat (Saverino et al. 2021).

Black and African American individuals are 40% more likely than non-Black and non-African American individuals to reside in regions projected to experience the highest increases in extreme temperature-related mortality with a 2°C rise of global warming. This likelihood rises to 59% with a 4°C rise of global warming (EPA 2021). Similarly, people who identify as Hispanic or Latino are 21% more likely to live in the hottest parts of cities, with 30% lacking access to air conditioning (NRDC 2016). Additionally, those who identify as Hispanic or Latino comprise nearly half of agricultural workers and 28% of construction workers in the United States, among whom heat related illnesses are very common (Goldman et al. 2021).

Certain populations may be more vulnerable to the negative health impacts of extreme weather events. For example, people who are economically burdened often lack the resources to prepare for, respond to, and recover from extreme weather events, living in higher-risk areas with less access to health care and facing greater challenges in evacuation and recovery. Older and disabled individuals may have limited mobility, complicating evacuation and access to emergency services, and are more susceptible to health issues related to extreme heat, poor air quality, and disruptions in medical care. Individuals identifying as Black or African American, American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, and/or Hispanic or Latino frequently reside in areas with higher environmental risks, having less access to health care and emergency services, and facing greater exposure to hazards and limited recovery resources due to structural inequalities (EPA 2021). For example, a survey conducted by

the Kaiser Family Foundation of New Orleans residents 1 year after Hurricane Katrina found that 32% of residents said their life remained “very disrupted” or “somewhat disrupted” by the storm, with this share rising to 59% of African American residents in Orleans Parish (KFF 2013).

Outdoor workers, particularly those in agriculture, construction, and landscaping, are at heightened risk of heat-related illnesses and other climate-related health impacts due to their prolonged exposure to extreme weather conditions. Farmworkers, who make up nearly half of the U.S. agricultural workforce and are disproportionately Hispanic, often work without adequate protections like shade, breaks, and water, increasing their vulnerability to heat exhaustion, heat stroke, and chronic kidney disease. They are also frequently exposed to pesticides, compounding their risk of adverse health effects. Due to precarious employment, many outdoor workers lack access to health care and may not receive timely treatment for work-related injuries or illnesses. This combination of environmental exposure and limited protections underscores the urgent need for targeted health and safety regulations to protect outdoor workers from the escalating impacts of climate change (Goldman et al. 2021).

Additionally, climate change exacerbates existing inequalities in access to clean water and sanitation. Although the United States has sufficient water to meet residents’ needs, disparities in access to clean water and sanitation threaten public health, which is exacerbated by climate change. Aging infrastructure leaves 2 million people without basic plumbing and more than 60 million with unsafe drinking water. Historical discrimination and underinvestment have disproportionately impacted Native American, African American, Hispanic or Latino, and low-income communities, resulting in significant health and economic burdens (Cushing et al. 2023). Households headed by people of color are 35% more likely to lack piped water compared with White, non-Hispanic households (Meehan et al. 2020). Historical redlining practices have also contributed to higher risks of asthma, particularly among Black and Hispanic children and in low-income neighborhoods (Ryan et al. 2024).

According to the U.S. Environmental Protection Agency’s Air Quality National Summary Report, approximately 100 million people in the United States live in communities where air pollution exceeds national air quality standards. Children, older adults, people with asthma, and people who are immunocompromised are most vulnerable to the negative effects of poor air quality. Furthermore, significant air pollution exposure disparities by race/ethnicity persist. For example, Black and Hispanic populations are exposed to significantly more PM_2.5 than they were responsible for based on consumption (Tessum et al. 2019, 2021). They also face disproportionately higher health burden as a result. For example, Black individuals

experience over three times the burden of PM_2.5-attributable cardiovascular mortality compared to non-Hispanic White individuals (Ma et al. 2023). These disparities partly reflect systemic environmental racism, including the enduring effects of discriminatory practices like redlining (Lane et al. 2022).

The intersection of these factors creates a compounding effect, where high-risk populations face greater exposure to climate-related health threats and have fewer resources to mitigate these risks, leading to profound health disparities that are likely to worsen as climate change progresses. There is a need to better understand which populations are most impacted and to develop targeted interventions. As discussed in the following sections, some populations, such as climate migrants and women, require focused attention due to their unique vulnerabilities.

Climate Migration and Health Challenges

Climate change is increasingly driving migration within the United States and globally, posing significant health challenges. As extreme weather events, rising sea levels, and other climate impacts worsen, more people are forced to relocate. This climate-induced migration brings numerous health risks and challenges for both the displaced populations and the communities that receive them (McMichael et al. 2012).

People displaced by extreme weather events, sea-level rise, and other climate impacts often face poor living conditions, limited access to health care, and increased vulnerability to diseases. Displaced populations may experience disruptions in managing chronic conditions, leading to worsening health outcomes. Overcrowded living conditions in temporary shelters can facilitate the spread of infectious diseases. Poor sanitation and limited access to clean water further increase the risk. Migration can also lead to mental health conditions, social disruption, and conflict (Bellizzi et al. 2023; McMichael 2023).

The communities that receive climate migrants may struggle to meet their health needs. For example, an influx of climate migrants can overwhelm local health care infrastructure, leading to resource shortages and reduced quality of care (Urban Institute 2023). Increased population density can strain public health resources, complicating efforts to manage both chronic and infectious diseases.

Gender Perspectives in Climate Health

Climate change impacts men and women differently, necessitating a gender-sensitive approach to health equity (WHO 2014). Women, particularly in low-income and rural areas, often have limited access to resources and decision-making

processes, making them more vulnerable to climate impacts. Pregnant women and women with young children face additional health risks from climate-related events such as heatwaves and food insecurity. Recent research highlights the heightened health risks for pregnant women exposed to extreme heat; for example, a prospective study from India found that outdoor pregnant women laborers face double the risk of miscarriage due to heat stress (Rekha et al. 2023). Promoting gender equity in climate health involves ensuring that women have equal access to adaptive resources, health care, and participation in resilience-building initiatives. Research should focus on the specific health impacts of climate change on women and the effectiveness of gender-responsive adaptation strategies.

Research Opportunities

• Understanding and Reducing Vulnerability: Research should aim to deepen understanding of how climate change interacts with social drivers of health, such as income, education, and housing stability, to influence exposure and vulnerability to health risks. Studies should identify strategies to reduce vulnerability, including targeted interventions for high-risk populations and the development of community resilience frameworks that address both immediate and long-term health threats. Moreover, strategies to reduce climate-related health inequities must include improving health care access, enhancing adaptive capacities, and addressing the underlying social drivers of health that contribute to these disparities. Key questions include: How effective are current strategies in reducing climate-related health inequities? What best practices can be identified and implemented to address these disparities? Which strategies are most effective for reducing vulnerability among high-risk populations? What role do specific social drivers, such as income and housing stability, play in shaping climate-related health risks, and how can they be mitigated?
• Mechanisms of Climate-Related Illnesses: Research should focus on uncovering the range of biochemical, molecular (epigenetic), cellular, socio-behavioral, and socioeconomic mechanisms that drive climate-related health impacts. This includes studying how climate-induced changes, such as temperature fluctuations, pollution, and altered ecosystems, not only affect biological systems (e.g., gene expression, immune responses, and the microbiome) but also interact with behavioral and socioeconomic factors. These factors include lifestyle changes, mental health responses, and social drivers of health, which together shape vulnerability and resilience to climate-related health risks. Understanding this range of mechanisms is crucial for

• developing targeted interventions, early warning systems, and adaptive health strategies to mitigate the long-term effects of climate change on human health. Key questions include: How do specific climate changes affect biological mechanisms underlying health risks? How can insights into these mechanisms inform targeted interventions? What adaptive strategies are most effective in mitigating long-term impacts?
• Longitudinal Studies on Climate and Health: There is a critical need for long-term studies that track the health outcomes of populations exposed to climate-related hazards over extended periods. Such research can uncover chronic impacts, such as mental health conditions and non-communicable diseases, which evolve over time. These studies should include diverse populations to understand the differential impacts of climate change on health across various demographic groups, considering factors like age, socioeconomic status, and geographic location. Key questions include: What chronic health impacts develop over time from climate exposure? How do factors like age, socioeconomic status, and geographic location affect vulnerability? Which preventive measures are most effective based on longitudinal insights?
• Quantifying the Health and Related Economic Burdens of Climate Change: The health and related economic impacts of climate change are significant but often under-recognized components of the broader climate crisis. Extreme heat, poor air quality, and climate-driven disasters like floods and hurricanes lead to increased hospital admissions, emergency responses, and long-term health care needs. Additionally, mental health impacts from climate stressors, such as heat and displacement, contribute to rising health care costs and lost productivity. Quantifying these health burdens, including direct costs (e.g., medical expenses) and indirect costs (e.g., productivity losses, economic disruptions from disease outbreaks), is essential to fully understanding the scope of climate-related health impacts. This research focus can provide policymakers with critical insights, enabling resource allocation that better reflects the true cost of climate change on human health and well-being. It also supports the development of targeted adaptation strategies for vulnerable populations, helping reduce health inequities and enhance resilience. Key questions include: What are the economic and health costs associated with climate impacts? How do mental health impacts and displacement contribute to these costs? How can economic data guide effective adaptation strategies?
• One Health Research: Future research should adopt a One Health approach that recognizes the interconnectedness of human, animal, and environmental health. Climate change disrupts ecosystems, increases zoonotic disease risks, exacerbates food insecurity, and fosters conditions that encourage antimicrobial

• resistance (AMR) (Burnham 2021; Magnano San Lio et al. 2023; Mora et al. 2022; Zinsstag et al. 2018). Research under a One Health framework can integrate surveillance across species to develop predictive models for disease outbreaks, assess sustainable agricultural practices for resilient food systems, and investigate AMR pathways in response to changing environmental conditions. By fostering biodiversity conservation as a public health strategy, One Health research can mitigate the cascading health impacts of climate-induced biodiversity loss and ecosystem disruption. Key questions include: How can a One Health approach improve predictive models for zoonotic disease outbreaks linked to climate change? How can surveillance across species be effectively integrated to monitor and respond to emerging health threats due to climate-driven ecosystem changes? How does climate change influence antimicrobial resistance pathways, and what strategies can mitigate its spread across human, animal, and environmental health domains?

DOMAIN 2: CROSSCUTTING STRATEGIES TO SUPPORT CLIMATE-HEALTH RESILIENCE AND INFRASTRUCTURE: ADAPTATION, MITIGATION, AND EQUITY IN ACTION

Effective climate-health resilience requires broad-based action and crosscutting strategies, including adaptation and mitigation, development of resilient and sustainable infrastructure, technological advancements, and policy innovation, as well as the prioritization of vulnerable communities and the integration of Indigenous knowledge. Adaptation refers to actions that help people and systems adjust to the current and future effects of climate change, enhancing resilience against climate impacts. Mitigation aims to limit the extent of global warming by reducing greenhouse gas emissions. Together, these strategies are critical to managing the impacts of climate change on human health.

There are numerous issues related to the potential benefits and possible adverse effects on human health resulting from mitigation and adaptation strategies (Luyten et al. 2023).

Climate change adaptation and mitigation measures can provide significant health co-benefits. For example, mitigation efforts such as reducing greenhouse gas emissions through cleaner energy sources and promoting active transportation (e.g., walking, cycling) can improve air quality, lower rates of respiratory illness, and increase physical activity, thereby reducing cardiovascular diseases and obesity. Adaptation strategies, like building green spaces and enhancing water management, can improve mental health, food security, and access to clean water while strengthening community resilience against climate-related stresses

(Mailloux et al. 2021; Patz et al. 2014). However, adaptation and mitigation also carry potential health risks. For instance, biofuel production can compete with food crops, impacting food security, and certain renewable energy projects may result in land displacement. Additionally, poorly planned adaptation infrastructure (e.g., flood defenses) can disrupt local ecosystems, creating new health hazards. This document does not aim to provide a comprehensive overview of research needs for mitigation and adaptation nor an exhaustive review of these approaches. Instead, it highlights broader strategies and research needs that can guide effective adaptation and mitigation, with detailed evaluations left to context-specific options and strategies.

This domain highlights overarching strategies and research needs that bridge climate adaptation and mitigation, with a focus on health equity and community resilience. It seeks to identify opportunities for implementing cross-sectoral, collaborative, and inclusive solutions to address the health impacts of climate change. By exploring the roles of infrastructure, technology, community engagement, and implementation science, this domain aims to support the development of comprehensive, equitable, and culturally attuned climate-health strategies.

Adaptation Strategies for Community Resilience

Building community resilience and promoting adaptation are crucial for mitigating the health impacts of climate change on populations living in vulnerable conditions (Mfitumukiza et al. 2020; Shammin et al. 2022). Community-based adaptation strategies, which involve local populations in the planning and implementation processes, are essential for ensuring that interventions are culturally appropriate and effective (Eriksen et al. 2021). Enhancing social and health infrastructure is another critical component. This includes developing climate–resilient health care systems that can withstand and quickly recover from climate-related disruptions. Additionally, integrating traditional knowledge and practices of Indigenous communities can offer valuable insights into sustainable adaptation strategies. Research should explore the effectiveness of various community-based adaptation initiatives and identify ways to scale successful models.

Mitigation Technologies

Innovative technologies are essential for reducing emissions and promoting health. Research into new technologies and methods for reducing greenhouse gas emissions, including advancements in renewable energy storage and sustainable urban planning, can mitigate emissions while supporting health systems. This

includes the development of climate-smart health care facilities that are designed to be energy-efficient and resilient to climate impacts (Corvalan et al. 2020). Leveraging digital solutions, such as telemedicine and health monitoring apps, can enhance health care delivery in the context of climate change (Rahimi-Ardabili et al. 2022). However, it is also critical to conduct life-cycle analyses that include health risk and benefit assessments, particularly for technologies such as lithium mining for battery production and other “clean” energy sources. These assessments help identify potential health risks across production stages and weigh them against environmental and health benefits.

Vulnerable Populations and Health Equity

Effective mitigation and adaptation strategies must prioritize vulnerable populations—such as older adults, women, children, low-income groups, and outdoor workers—who face disproportionate health risks from climate change (EPA 2021), as discussed above in Domain 1. Research should focus on identifying the unique vulnerabilities and needs of these groups, examining how social drivers like economic status, access to health care, and housing conditions influence their exposure and ability to adapt. Developing targeted interventions that promote health equity is essential to reducing climate-related health disparities and ensuring that all populations are supported in their resilience-building efforts.

Indigenous Health and Traditional Knowledge

Indigenous populations are among the most affected by climate change, yet they possess extensive traditional knowledge that can contribute to resilience-building (Schramm et al. 2020). Respecting and incorporating this knowledge into health adaptation strategies is vital. Indigenous communities often rely on their environment for sustenance and cultural practices, making them particularly vulnerable to environmental changes. However, their traditional practices and deep understanding of local ecosystems can offer sustainable solutions to climate challenges. Research should document and integrate traditional knowledge with scientific approaches to develop comprehensive adaptation strategies that honor and leverage Indigenous wisdom.

Implementation Science

Implementation science focuses on the methods that best promote the integration of research findings into policy and practice. This is essential for

translating climate and health research into actionable strategies (Neta et al. 2022). Understanding the barriers to implementation, such as lack of resources or political will, and developing frameworks to overcome these barriers is critical. Implementation science also emphasizes the importance of stakeholder engagement, ensuring that communities, health care providers, and policymakers are all involved in the development and execution of climate-health interventions.

Collaboration and Community Engagement

Fostering collaboration between various sectors and engaging communities in the planning and implementation of climate-health strategies are fundamental for building resilience. Collaborative efforts between governmental agencies, non-profits, and the private sector can enhance resource allocation and policy development. Community engagement ensures that the voices of those most affected by climate change are heard, and their needs are addressed. Participatory approaches, where community members are actively involved in research and intervention planning, can lead to more effective and sustainable solutions (Bardosh et al. 2017).

Research Opportunities

• Integration of Mitigation and Health Co-Benefits: Research should assess and quantify the health benefits of reducing greenhouse gas emissions and other mitigation strategies. For example, studies could examine how transitioning to cleaner energy sources impacts respiratory health by reducing air pollution. Key questions include: What are the most effective mitigation strategies that provide direct health co-benefits? How can a health-first approach, grounded in local health priorities, guide decision making to ensure that public health needs influence the implementation of climate mitigation interventions? What role do local health priorities play in implementation?
• Community-Based Adaptation Strategies: Understanding the effectiveness of community-driven adaptation strategies is critical for building resilience, especially among populations living in vulnerable conditions. Future research could investigate how localized, community-based interventions—such as urban greening or water management projects—can be tailored to address specific climate and health challenges. Key questions include: What are the most successful community-based adaptation models? How can these models be scaled or adapted across different cultural and environmental contexts? What methods support community-driven solutions in diverse areas?

• Targeting Vulnerable Populations and Addressing Equity: Future research should prioritize understanding how climate change interacts with social drivers of health—such as income, education, access to health care, and housing stability—that influence the vulnerability of specific populations, including older adults, women, children, and low-income groups. Studies should focus on developing targeted strategies and interventions that promote health equity by addressing these social drivers and reducing climate-related health disparities. Key questions include: How can climate-health interventions be designed to address the unique needs of vulnerable populations? What policies and practices can be implemented to mitigate the compounded effects of climate change and social inequities? How does socioeconomic status shape climate-health vulnerabilities?
• Leveraging Indigenous Knowledge: Indigenous communities possess traditional knowledge that can contribute to effective adaptation strategies. Research should focus on documenting and integrating this knowledge with scientific approaches to create comprehensive, culturally appropriate adaptation frameworks. Key questions include: How can traditional Indigenous practices be systematically incorporated into climate adaptation strategies? What are the barriers and opportunities for integrating Indigenous knowledge into policy and practice? What opportunities support collaboration with Indigenous communities?
• Implementation Science for Climate-Health Interventions: Implementation science can help bridge the gap between research and practice by focusing on the best methods for integrating climate-health interventions into health care systems and policies. Future research should address questions such as: How effective are current climate-health interventions in reducing exposure and health impacts? For example, do early warning systems, air conditioning, and white roofing measures effectively mitigate climate-related health risks? Empirical studies suggest that some of these interventions may not yield expected outcomes, underscoring the need to evaluate which measures are most effective in various contexts. Additional questions include: What are the barriers to implementing effective climate-health interventions? How can stakeholder engagement be enhanced to support the uptake of evidence-based practices in diverse settings?
• Developing Resilient Health and Infrastructure Systems: Future research should focus on designing and testing resilient health systems and critical infrastructures, such as water, sanitation, and energy systems, that can withstand and adapt to climate impacts. This research should include exploring sustainable, climate-adaptive technologies and practices that enhance the

• ability of health systems to respond to climate-related disruptions, thereby safeguarding public health during extreme events. Key questions include: What technologies are most effective for building climate-resilient health systems? How can critical infrastructure be adapted to reduce climate-related health risks? What factors contribute to the successful implementation of resilient health infrastructures?

DOMAIN 3: RESEARCH AND TECHNOLOGY INFRASTRUCTURE AND CAPACITY BUILDING

The climate change and related health crisis is complex, spanning numerous sectors and disciplines. Its wide-ranging impacts demand solutions that involve various sectors and stakeholders, necessitating different types of research than in the past. This domain underscores the critical need to enhance research infrastructure and capacity to address these multi-faceted health impacts effectively.

Research Infrastructure and Ecosystem: Interdisciplinary Research and Longitudinal Studies

A robust research infrastructure is essential for advancing knowledge on climate change and health. This involves integrating climate science and health research, conducting longitudinal studies, and fostering collaboration with social sciences and economics. Building a comprehensive research ecosystem can enhance our understanding and response to climate-related health risks (Corell et al. 2014).

Data Gaps and Capacity Building in Communities Living at the Intersection of Vulnerable Conditions

Data relevant to climate and health are not collected at consistent geographic and temporal scales (Schramm et al. 2021). Addressing data gaps and building research capacity, especially in communities facing vulnerable conditions, are critical for understanding and mitigating the health impacts of climate change. This includes improving data collection, enhancing analytical capacity, and ensuring that communities facing vulnerable conditions have the tools and resources to conduct and benefit from climate-health research. Mapping can be used to better characterize vulnerability and understand how populations experience risks associated with exposure to climate-related hazards (Schmeltz et al. 2019).

Harnessing New Technology Including Sensing, Forecasting, Artificial Intelligence, and Modeling

New technologies, including artificial intelligence (AI), sensing, forecasting, and modeling, offer significant potential for advancing climate-health research. These technologies can improve predictive models, enhance data analysis, and support the development of innovative solutions to climate-health challenges. For example, researchers have used machine learning to study how global warming has contributed to heat waves in the United States in recent years (Trok et al. 2024). Advanced sensing technologies, like remote sensing and satellite systems, provide high-resolution environmental data that can be integrated with health data to predict climate-related health risks, such as heat stress, vector-borne diseases, and air pollution (Zhao et al. 2023). Forecasting technologies, including AI-driven models, simulate climate scenarios to anticipate health impacts, aiding in emergency preparedness and targeted public health responses.

However, it is important to recognize that AI’s enormous energy requirements pose challenges to the transition to renewable energy. Without substantial advancements in making AI more energy-efficient, its large-scale deployment could strain renewable resources and counteract some climate mitigation efforts. Research opportunities should therefore include exploring sustainable AI practices that balance the benefits of AI-driven climate-health solutions with the need to reduce energy consumption and environmental impact.

Climate-Savvy Workforce

Building a climate-savvy workforce is essential for addressing the health impacts of climate change (Kreslake et al. 2018; Maibach et al. 2021). However, there is a need to improve health professionals’ education and training around climate and health–related issues (Albrecht et al. 2023). This involves training health care professionals, including students and trainees, on climate-related health issues; facilitating meaningful dialogue; and enhancing the capacity of public health systems. Furthermore, as trusted messengers, health professionals are powerful advocates for climate solutions.

Funding Mechanisms

Securing adequate funding is essential for advancing climate-health research and implementing effective interventions. This involves developing innovative funding mechanisms, leveraging public- and private-sector resources, and

ensuring that funding is directed toward the most critical research areas (UCSF Institute for Global Health Sciences and Open Consultants 2023).

Research Opportunities

• Building Interdisciplinary Research Ecosystems: Future research should explore strategies to integrate climate science, health research, and social sciences. Key questions include: How can interdisciplinary research on climate and health be promoted and supported? What are the key challenges and opportunities in conducting longitudinal studies on climate change and health impacts? How can collaborations with social sciences and economics enhance climate-health research?
• Enhancing Climate-Health Surveillance and Data Collection Systems: Research should focus on developing robust, real-time surveillance systems that integrate climate, environmental, and health data. This will help in accurately assessing the health impacts of climate change and inform timely public health interventions. Studies should explore innovative data collection methods, including the use of remote sensing, AI, and community-based monitoring to fill gaps in climate and health data, particularly in underserved and vulnerable communities. Key questions include: How can innovative data collection methods address climate-health data gaps? What role do remote sensing, AI, and community-based monitoring play in improving climate-health data systems?
• Addressing Data Gaps and Enhancing Capacity in Vulnerable Communities: Research is needed to develop innovative approaches to address data gaps, particularly in vulnerable communities that are disproportionately affected by climate change. This includes improving data collection methods, enhancing analytical capacity, and ensuring that these communities have the necessary tools to engage in and benefit from climate-health research. Future research questions include: What are the most significant data gaps in climate and health research at the community level, and how can they be addressed? How can research capacity be built in communities to support local climate-health studies? What strategies are effective for improving data collection and analysis in resource-limited settings?
• Harnessing Emerging Technologies for Climate-Health Research: The integration of new technologies, such as sensors, AI, advanced modeling, and big data analytics, holds promise for advancing climate-health research. Research should explore how these technologies can be leveraged to improve sensing, data collection, forecasting, and predictive models; enhance data

• analysis; and develop innovative solutions to health challenges posed by climate change. Important questions include: How can AI be leveraged to improve predictive models for climate-related health risks? What are the best practices for integrating AI and modeling into climate-health research? What ethical considerations need to be addressed in using AI and modeling for climate-health research?
• Developing a Climate-Savvy Workforce: Strengthening the capacity of health care professionals and researchers to address climate-related health issues is critical. Fostering collaborations between health care providers, clinicians, and public health experts is essential to bridging the knowledge gap and reducing siloed approaches. Collaborative training and shared learning can enhance the integration of climate-health interventions into both clinical and public health practices. Research should focus on identifying the most effective training programs and strategies to build a climate-savvy workforce. Key questions include: What are the most effective training programs for health care professionals on climate-related health issues? How can public health infrastructure including dependencies across sectors be strengthened to better respond to climate-health challenges? How can we foster collaboration between clinicians and public health experts to ensure a more unified approach to climate-health interventions?

DOMAIN 4: POLICY AND PUBLIC COMMUNICATION, EDUCATION, AND ENGAGEMENT

Policy and Governance for Climate Adaptation and Mitigation

There is an important need for research to provide evidence-based policy and effective governance. Science is critical to decisions for actions of mitigation and adaptation to protect health and achieve resilience. Effective policy is needed to transform climate and health research into actionable solutions that protect communities and ecosystems. Effective policies create regulatory and funding structures that support interdisciplinary research, equitable resource distribution, and the development of solutions that address the health effects of climate change. Governance frameworks establish standards that ensure research is conducted transparently, engages affected communities, and leads to policies that prioritize those most at risk. Evidence-based guidelines ensure that actions benefit all communities, particularly those disproportionately affected by climate change, by embedding equity considerations into policy design and implementation. Without sound policy and governance, climate and health research and actions

risk being fragmented, underfunded, or disconnected from the urgent needs of affected populations.

Studying the roles of policy frameworks and governance structures will aid in facilitating effective climate and health strategies and in identifying ways to enhance coordination and implementation at local, national, and global levels (Marten et al. 2021; WHO 2023). Policies should not only be evidence based but also prioritize the needs and lived experiences of people in vulnerable conditions, incorporating their knowledge to design and implement meaningful interventions. Moreover, studying successful policy mechanisms from different contexts can provide insights into best practices for scaling solutions, ensuring equitable access to resources, and building climate-resilient health systems. Research into policy effectiveness can highlight which strategies yield the most significant health and environmental benefits, incentives for private-sector engagement, and models for cross-sector collaboration and ensure that decision makers prioritize solutions that are both scientifically sound and socially equitable.

A crucial aspect of policy and governance in climate and health research is the role of accountability and sustained commitment. Even the most well-designed policies can falter without mechanisms to monitor progress, evaluate effectiveness, and ensure compliance across sectors. Accountability mechanisms can measure real-world impact, prevent unintended consequences, and ensure long-term commitment. Transparent governance structures help track the impact of climate-health policies, allowing for adjustments based on new evidence and emerging challenges. Finally, fostering global cooperation through policy alignment and knowledge sharing can help nations address transboundary climate and health challenges more effectively, reinforcing the need for strong governance mechanisms that operate at multiple levels.

Public and Policy Engagement and Education as a Bi-Directional Process

Public engagement and education play a crucial role in addressing the health impacts of climate change (Khatibi et al. 2021). This domain emphasizes the bi-directional nature of education, where knowledge dissemination is paired with learning from the public’s lived experiences, insights, and concerns. Such a collaborative approach not only enhances the scientific understanding of climate-health linkages but also builds community resilience by fostering trust and inclusivity in public health interventions.

Existing research highlights the importance of engaging communities directly affected by climate change. Populations living in vulnerable conditions,

including those in low-income regions and areas prone to climate hazards, often possess valuable knowledge and adaptive strategies that can inform effective interventions. These communities also often have first-hand knowledge of the barriers to successful implementation of interventions, providing critical insights into practical challenges and potential solutions.

In addition, it is essential to reach members of the public who may be more cautious, disengaged, doubtful, or dismissive regarding climate change, recognizing their perspectives and addressing their concerns. Developing targeted strategies to engage these groups can help build a broader base of support for climate and health action and foster more inclusive dialogue. For example, recent findings from a global study suggest that liberals and conservatives take action on climate issues at similar rates, despite differing beliefs, with conservatives acting despite their climate skepticism. The study found that interventions like emphasizing effective collective actions or writing to a future generation boosted climate beliefs and policy support across the ideological spectrum (Berkebile-Weinberg et al. 2024). For certain groups, it may be effective to approach climate engagement through economic arguments and emphasize the benefits of energy innovation, which can appeal across the political spectrum. Addressing climate-related health risks in the context of economic resilience, job creation, and energy independence can resonate with these audiences and foster broader support for climate-health initiatives. Furthermore, addressing the issue of disinformation is critical. Public engagement efforts should include strategies to counter disinformation related to climate science and health, empowering communities with accurate information while building resilience against misleading narratives.

There is a need for more robust frameworks to support meaningful public engagement and the integration of community input into climate and health policy and practice. In addition, there is a need to develop inclusive participatory processes that ensure diverse community voices are heard and that public engagement efforts are sustained over time to build long-term resilience (NASEM 2022). Finally, engaging policymakers is crucial to ensure that climate and health research informs effective and equitable policy decisions at all levels. Engaging policymakers with a range of ideological perspectives, including those who may respond to economic and energy innovation arguments, can help bridge divides and lead to practical policy solutions. Framing climate-health action as a pathway to economic growth and technological advancement may increase bipartisan support for interventions. By fostering dialogue and understanding between researchers and policymakers, we can bridge the gap between scientific evidence and practical policy solutions, ultimately leading to more impactful climate and health actions.

Research Opportunities

• Policy and Governance for Climate Adaptation and Mitigation: Examining the role of policy frameworks and governance structures is essential for facilitating effective adaptation strategies. Future research could investigate how existing policies can be reformed or new policies developed to better support climate adaptation efforts that prioritize health equity. Key questions include: How can policy frameworks be optimized to enhance coordination and implementation of climate-health strategies? What governance models best support the inclusion of marginalized communities in adaptation planning?
• Enhancing Two-Way Communication: Future research should explore the most effective methods for two-way communication between scientists and the public, especially in marginalized and underserved communities. This includes creating collaborative environments where researchers and communities learn from each other. Key questions include: How can public input be systematically integrated into climate-health research? What are the most effective strategies for fostering mutual education, where both researchers and communities learn about climate risks and solutions from each other, empowering them to take collective action? What impact does public engagement have on intervention effectiveness? Additionally, there is a need for research on the impact of public engagement on the effectiveness and sustainability of health interventions.
• Developing Inclusive and Equitable Engagement Frameworks: Opportunities for future research include developing frameworks for community-based participatory research that prioritize equity and inclusivity, exploring digital and social media platforms for wider engagement, assessing approaches to counter disinformation, and evaluating the impact of public education on behavioral change related to climate adaptation and mitigation. By advancing our understanding of these areas, this domain aims to create more effective, inclusive, and culturally relevant climate and health interventions. Key questions include: What inclusive frameworks best support community engagement? How can digital platforms broaden engagement? What are effective approaches to countering climate-health disinformation?
• Effective Climate-Health Communication for Policymakers: In addition to the public, it is important for policymakers to be educated and informed about the climate crisis. Future research should investigate the most effective strategies for communicating climate-health science to policymakers at local, state, national, and international levels. For example, this could include developing frameworks for translating complex scientific findings into clear, actionable policy recommendations that can guide decision making. It is

• also important to educate policymakers through targeted workshops, policy briefs, and interactive decision-support tools that enhance understanding and facilitate evidence-based action. Key questions include: What frameworks can translate scientific findings for policymakers? What communication strategies are most effective with policymakers across ideological perspectives?

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