Framing IR in climate change and health

Addressing common implementation challenges

CCH interventions face many barriers during implementation. While these challenges are highly context-specific, Table 2 outlines some of the common and systemic reasons why interventions fail.

Implementing CCH interventions can face significant barriers, but these challenges are not insurmountable. Many initiatives fail not because they lack merit, but due to systemic issues such as fragmented policies, unsustainable funding, inadequate data systems and a lack of community engagement.

IR provides a structured, evidence-informed approach to understanding and addressing implementation barriers and bottlenecks. By identifying what works, for whom and under what conditions, IR helps practitioners and policy-makers tailor solutions to real-world contexts.

To overcome these barriers, governments can prioritize integrating climate adaptation into national health strategies, ensuring policies translate into actionable, well-funded interventions. A shift from short-term donor dependency to long-term investment is crucial for building resilient health systems. Furthermore, strengthening data infrastructure enhances predictive capabilities and enables better decision-making. Equally important, interventions must be designed with communities rather than imposed on them, ensuring trust, relevance and uptake.

By applying IR to these persistent challenges, CCH strategies can transition from fragmented short-term efforts to scalable and impactful programmes that safeguard public health in a changing climate.

Tools for capacity assessment

Interventions often focus on the what (e.g. vaccination programmes, AI-driven disease tracking, early warning systems) but neglect the how (i.e. who will run it, what infrastructure is needed and whether local teams can sustain it once external support is gone). Conducting a capacity assessment can help expose weak points before they derail an intervention.

Capacity assessment in CCH implementation involves evaluating the ability of health systems, institutions and communities to effectively integrate and sustain climate adaptation strategies. This process helps identify gaps, strengths and opportunities for improving resilience against CCH risks.

Key aspects of capacity assessment for CCH IR projects are:

• Institutional capacity: evaluates whether government agencies, health ministries and nongovernmental organizations (NGOs) have the necessary policies, governance structures and coordination mechanisms for CCH adaptation.
• Workforce and training capacity: assesses the skill levels, availability and preparedness of health workers to manage climate-sensitive diseases and extreme weather-related health emergencies.
• Infrastructure and resource availability: identifies gaps in health care facilities, data systems and logistics that may hinder climate resilience.
• Community and stakeholder engagement: examines the role of local communities, traditional knowledge and multisectoral partnerships in adapting to CCH challenges.

There is no single “best” capacity assessment tool – different tools exist depending on the sector, target audience and level of intervention. Some are designed for high-level institutional capacity-building, while others focus on local, community-based resilience.

Framing IR questions for CCH

CCH adaptation interventions

According to the IPCC Sixth Assessment Report (2023), 3.6 billion people on the planet already live in areas susceptible to climate-related hazards. It is both urgent and necessary to adapt life on Earth to the impacts of climate change, especially for the most vulnerable populations – and this need for adaptation measures is expected to increase.³⁷

Despite growing climate-related risks, current adaptation efforts are not sufficient to protect public health – particularly in LMICs where structural inequalities limit access to funding and technical resources.⁴¹ The gap between climate risks and health system readiness remains a significant challenge.

There are many interventions that can be employed to reduce the health impacts of climate change, as well as strategies to support individuals, organizations, communities and countries to become more resilient to CCH risks.⁴² These include:

Strengthening health systems:⁴³

• Enhancing surveillance for climate-sensitive diseases (e.g. dengue and heat-related illnesses).
• Increasing health care capacity to manage the health impacts of extreme weather events, such as floods and heatwaves.
• Building capacity among health care workers to adequately respond to climate-related events.

Climate-resilient infrastructure:⁴⁴

• Designing hospitals, water systems and housing to withstand extreme weather events.
• Promoting green infrastructure, such as urban tree planting to mitigate heat stress.

Early warning systems:⁴⁵

• Such mechanisms help predict and reduce health impacts, support emergency planning and guide responses across all levels of the health system.
• When an extreme heat event is expected, early warnings are followed by practical recommendations on protective actions, helping to reduce negative health outcomes.

Community-based approaches:⁴⁶

• Empowering communities to play a central role in planning and decision-making processes.
• Education on health risks associated with climate change.

Housing-related heat exposure:⁴⁷

• Reducing exposure at housing levels (e.g. through cooling roofs) are proven to be low-cost and still highly effective solutions to reduce vulnerability of lower-income populations.

Yet, implementation and scale-up remains a central challenge, largely due to limited investment.¹⁸

Mitigation and health co-benefits

Mitigation focuses on reducing the progression of climate change, primarily by addressing the primary cause: cutting down greenhouse gas emissions. Recent record CO₂ emission rates⁴⁸ and global mean temperatures suggest that mitigation is underperforming and demands extra scientific attention. The health sector is responsible for a significant share of greenhouse gas emissions and, consequently, for an important number of direct and indirect deaths.

Co-benefits are strategies that simultaneously address climate change and result in secondary gains. They can be a powerful incentive to accelerate behavioural and policy changes, as the population observes the short-term benefits, while the consequences of the mitigation are experienced in the long term.⁴⁹ For example, reducing greenhouse emissions improves air quality, which also reduces respiratory illnesses.

Setting IR questions for CCH interventions

IR can help identify, understand and develop strategies for “overcoming barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based climate and health interventions”.⁵⁰

Table 3 outlines some sample IR questions for assessing adaptation and mitigation activities in the context of CCH.

For newer interventions with limited data on their effectiveness, IR studies should consider investigating both effectiveness as well as any barriers to implementation.