Stakeholders and context in climate change and health IR

Multisectoral and cross-disciplinary collaboration

CCH challenges cut across multiple sectors and disciplines. No single sector can address these issues in isolation – solutions must be integrated, coordinated, multisectoral and responsive to diverse stakeholder needs.^7,¹⁹

The Barbados case study describing the development of a dengue early warning system (EWS), highlights the value of engaging multisectoral stakeholders.¹⁸ Multisectoral and cross-disciplinary approaches to CCH interventions help improve sustainability and impact.¹⁶

When assembling CCH IR teams or mapping key stakeholders, researchers should consider including a range of disciplines as outlined in the section Stakeholder mapping in CCH interventions. Leveraging expertise from different fields helps ensure interventions are evidence-based, well-informed and context-specific. Additionally, aligning policies across sectors helps prevent contradictions – such as environmental policies aimed at improving air quality being undermined by industrial expansion incentives.

Adopting a collaborative approach can also increase resource efficiency, reduce duplication of efforts and maximize overall impact. Given the complexity of these interactions, stakeholder mapping is essential for identifying key actors, understanding power dynamics, and ensuring coordinated action across sectors.

Challenges in cross-disciplinary collaboration

While cross-disciplinary collaboration is crucial for effective CCH interventions, it is not without its challenges. These include:

Communication barriers – different fields use different terminologies, conceptual frameworks and implementation approaches.
Conflicting priorities – different sectors may have different and/or additional goals to those of the health sector.
Funding constraints – multisectoral projects require sustained funding and commitment.

To overcome these barriers, multisectoral steering committees, joint priority-setting exercises, and memorandums of understanding (MOUs) can formalize common goals, as well as expected roles and responsibilities.

Stakeholder mapping in CCH interventions

“In building climate-resilient health systems, incorporating inputs from stakeholders and target populations is valuable in developing quality improvement and optimization measures” according to Boyer, Bowen and Murray (2020).¹³

As outlined in the toolkit module How IR works, analysing and engaging stakeholders is a critical step in understanding the context of an intervention and helping guide its effective implementation.

The following key stakeholder groups should be considered for CCH IR:

Government agencies – set policies and allocate resources.
NGOs and community groups – ensure grassroots implementation.
Health workers and researchers (including climate and social scientists) – provide scientific evidence, data and insights on health, climate and social dynamics.
Economists and policy advisers – assess costs, benefits and financing mechanisms for interventions.
Urban planners, engineers and industry partners – develop climate-resilient infrastructure and technologies, and provide resources.
Media and communication experts – raise public awareness and facilitate behaviour change campaigns.
Affected communities – ensure interventions are culturally meaningful, acceptable and feasible in real-world settings.

There are many approaches to stakeholder mapping, each offering different insights into how actors interact, influence decisions and contribute to implementation efforts. See box: MapStakes for an example resource.

Community engagement and the role of co-design in CCH

Interventions are more effective when developed with – rather than for – the communities they aim to benefit. The design of CCH interventions should consider whose needs are being addressed, who is leading the design and implementation and “the agency of communities, and work to leverage assets or resilience points, rather than simply copying and pasting solutions with fixed components from elsewhere.”²³

A number of community participatory approaches are employed by researchers24with varying degrees of inclusion of community stakeholders. IR requires methods of participation that help facilitate genuine co-creation and inclusion of lay and professional community members, and other key stakeholders, throughout the research process. This increases trust, equity and inclusivity, making interventions more relevant and sustainable, particularly when working with marginalized or fragile populations.

Authentic involvement of stakeholders from local communities requires creative engagement approaches and a redistribution of research budgets to support meaningful community participation (as described in the case study: The lived experience of climate change in Dhaka, Bangladesh). Unlike traditional expert-driven models, co-design recognizes the lived experiences of affected communities as essential expertise. Fig. 4 outlines the key principles, benefits and challenges of using a co-design approach in community engagement.

Incorporating lived experience in CCH IR

Individuals and communities who have experienced climate-related health impacts first-hand can provide valuable insights into barriers to adoption, cultural sensitivities and unexpected consequences of interventions. These perspectives often highlight issues that may be overlooked by policy-makers and researchers and make interventions more relevant and accepted by the communities they are intended to serve.²⁵

Capturing lived experience requires research methods that allow communities to express their perspectives, challenges and priorities in their own words, for example in-depth interviews, focus group discussions and photovoice.²⁶ See case study: The lived experience of climate change in Dhaka, Bangladesh.

An intersectional approach ensures that IR reflects diverse lived realities – such as women, older adults and people with disabilities – who may experience unique barriers to adapting to climate-related health risks. By using these participatory methods, CCH IR can move beyond one-size-fits-all solutions and support inclusive, effective and locally-driven responses to climate challenges and impacts.

Tailoring CCH interventions to different contexts

To be effective, CCH interventions must address context-specific environmental, social and infrastructural challenges. These challenges vary widely by geographic region and socioeconomic setting, requiring tailored interventions that address the most pressing local challenges in the most impactful and sustainable ways.

This section explores the influence of place (e.g. urban, rural or peri-urban) and economic context (e.g. high-income versus low-income settings) on CCH interventions. It also considers how climate change can deepen existing health inequalities, highlighting the importance of equity and the differential impacts on vulnerable groups.

More wide-ranging CCH interventions would also benefit from diverse data drawn from multiple settings – such as tropical versus temperate zones, different disease burdens and varying socioeconomic conditions – captured through targeted monitoring in ecologically and climatically distinct regions.²⁹ Data sources are addressed in section 4.

Urban, rural and peri-urban settings

Urban, rural and peri-urban areas each present distinct challenges and require targeted approaches.

Over half of the world’s population live in cities, with the UN predicting this will reach over two-thirds by 2050.²⁹ Urban settings often have well-developed infrastructure but factors such as population density create “complex microclimates”²⁹ that can heighten climate risks.

Rural areas are often reliant on climate-sensitive livelihoods, increasing vulnerability. Peri-urban areas – where rapid urbanization meets rural infrastructure gaps – experience a blend of climate risks from both settings, which necessitates combined approaches. Fig. 5 outlines the different primary climate risks in each setting and key interventions to address them. Box 4 describes examples of contextualized CCH interventions in each setting.

High- and low-income countries

Economic factors also shape CCH interventions. High- and low-income countries face different challenges and require distinct strategies based on economic capacity, governance structures and health care infrastructure.

High-income countries (HICs) typically have stronger health systems and climate adaptation policies, which allows for a greater focus on mitigation and use of technology.

For example:

AI-driven disease modelling to predict and respond to climate-sensitive health risks.
Precision public health strategies, integrating climate and health data for targeted interventions.
Emission reduction policies, such as green hospital initiatives and sustainable transport in health care services.

Low- and middle-income countries (LMICs) often face financial constraints, weak infrastructure and greater climate vulnerability. Interventions should prioritize adaptation and resilience, for example:

Low-tech early warning systems, such as community radio and SMS-based heatwave alerts.
Decentralized health care solutions, including mobile clinics and community health workers.
Climate-adaptive agriculture and nutrition programmes, reducing malnutrition linked to food insecurity.

While approaches should be context-specific, cross-country learning is also critical for bridging knowledge gaps. HICs can support LMICs through technology transfer, financing and technical expertise, while LMICs offer valuable insights from community-driven resilience and low-cost adaptation strategies. This two-way learning enhances the effectiveness, equity and sustainability of CCH interventions.

Addressing health inequities and vulnerabilities in CCH

Islam and Winkel (2017) describe climate change as “a vicious cycle, whereby initial inequality causes the disadvantaged groups to suffer disproportionately from the adverse effects of climate change, resulting in greater subsequent inequality”.³³ Addressing inequality both within and between countries is essential for strengthening CCH interventions³⁴ and ensuring that climate change does not exacerbate existing health inequalities.^12,¹⁶The ND-GAIN Country Index (see Box 5) is a useful tool for understanding country-level vulnerabilities to climate change and readiness to adapt.

All too often it is vulnerable people and groups who are most at risk of negative health (and broader societal) impacts of climate change.^16,³⁶ People living in poverty are also more susceptible to these negative health impacts. For example, as climate change increases the spread of waterborne disease, those without access to piped water face a greater risk of contracting diarrhoea.³³ Many of these vulnerabilities are rooted in historical and structural inequalities and unequal access to resources. Addressing these underlying drivers is critical to ensuring that climate change does not further entrench existing health inequities. Table 1 outlines some of the biological and socioeconomic impacts facing different vulnerable groups in the context of CCH.

Implementation researchers should ensure that project design considers the needs of high-risk, marginalized and underserved groups12and avoids unintended negative impacts of interventions that could drive further inequality.¹⁶ Co-designing interventions with local communities at the outset of a project can help ensure that outcomes are aligned with local priorities, resources, needs and values, and do not worsen existing health inequities.

Women are particularly vulnerable to climate change challenges.³⁶ Researchers should refer to the toolkit module on Developing implementation research projects with an intersectional gender lens to better understand how gender intersects with other social factors in the context of IR.

By taking these vulnerabilities into account, IR can help bridge the health equity gap.³⁷ IR frameworks such as the Consolidated Framework for Implementation Research (CFIR) and Reach Effectiveness Adoption Implementation Maintenance (REAIM) provide a structured approach to understanding context and identifying strategies to improve CCH intervention adoption among marginalized groups.³⁸

Systems thinking in CCH interventions

As outlined, climate change does not impact health in isolation – it interacts with environmental, social, economic and political systems. This complexity calls for a systems thinking approach that acknowledges these interdependencies and helps design interventions that are holistic, equity-focused, sustainable and tackle multiple drivers of risk.^29,³⁹

Unlike traditional, linear cause-and-effect approaches, systems thinking tries to anticipate unintended and/or indirect consequences and promote solutions that address root causes rather than just symptoms. For example, traditional intervention design might focus on distributing mosquito nets to reduce malaria transmission, whereas a systems thinking approach would also examine broader determinants of malaria risk, such as water management, housing quality and socioeconomic vulnerabilities.

This approach also helps to ensure long-term sustainability as interventions anticipate future challenges and design for adaptability over time.

A key example of a collaborative, systems-based approach is One Health:¹² “an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems” (One Health High-Level Expert Panel (OHHLEP)⁴⁰). For more details on how to integrate a One Health approach into IR, researchers should explore the related module in this toolkit.