In this blog post Anna Beswick, Head of Climate Ready Leadership at Sniffer, introduces a new Adaptation Scotland, Public Health Scotland and Improvement Service briefing on Working together to build climate resilient, healthy and equitable places. Read on to hear more about the briefing and Anna’s learning points.

We know that the impacts of climate change have profound, direct implications for human health. The human cost of the current European heat wave is in the headlines as I write this blog with stories of fatalities and health impacts at the forefront. Sadly, this is just the latest in a long line of stories that bring home the undeniable connection between health and climate change.

Direct health impacts, such as death or injuries resulting from extreme flood events or high temperatures, are often the first things that come to mind when we consider climate and health. It is critical that direct impacts are understood and acted on, however, those of us responsible for leading action to adapt to climate change also need to deepen our understanding of the ways that climate impacts and adaptation responses indirectly influence health impacts and health inequalities. Our new Adaptation Scotland briefing, developed with Public Health Scotland and the Improvement Service ‘Working together to build climate resilient, healthy and equitable places’ provides an easy to read introduction to this topic. It is a useful conversation starter and practical resource for sustainability and public health professionals, elected officials and those working across local government.

Through working on the briefing I’ve learnt much more about how health inequalities play out in Scotland. Health inequalities are unjust and avoidable differences in people’s health across the population and between specific population groups. In Scotland life expectancy at birth is 77 years for males and 81 years for females. However, men in the most deprived areas die around 14 years earlier and women 11 years earlier than those in the most affluent areas. Life expectancy is going down among the least well-off in our society and the evidence indicates that health inequalities are widening.

It is clear to me that the challenge of reducing health inequalities and increasing resilience to climate change are interconnected. The link between climate change and direct health impacts is understood in general terms and is frequently cited in adaptation plans and strategies developed for different places or organisations. There is much less understanding and capacity to address the ways in which climate impacts indirectly affect health. The new briefing is a first step in addressing this challenge.

Below are some of my personal learning and highlights from this work and examples of initial actions that we are taking at Sniffer:

• Understanding that the root causes of health inequalities are driven by inequalities in income, power and wealth. Power dynamics in particular have struck a cord with me. At Sniffer we’ve recently developed a new climate vulnerability framework which will guide how we address climate vulnerability across our projects and programmes and power is integral to this. We’ve also worked with partners to ensure that the governance and principles of pioneering initiatives like Highland Adapts, are rooted in shared power and committed to genuinely involving people in locally led adaptation. As we consider how the procedural elements of climate justice can be realised in Scotland we need to do much more to address imbalances in power both through local projects and at a national level. Our work to develop innovative approaches to adaptation finance also need to consider inequalities in income and wealth and specifically who benefits from investment in adaptation.
• Being more aware of what public health professionals refer to as ‘upstream and downstream’ interventions. This acknowledges that some of the biggest opportunities to address health inequalities are found in influencing high level policy, investment, and strategy decisions. These do not rely on the capacity of vulnerable individuals to engage and advocate for their interests and have the potential to influence system change. This stresses to me the importance of health in all policies, including climate adaptation plans, strategies and investments. We need to ensure that large scale adaptation strategies, actions and investments are planned with equity and health co-benefits in mind – for example, making sure that new green, blue infrastructure is accessible for vulnerable groups and designed with communities. Downstream interventions, such as in-depth targeted support to help vulnerable communities and individual access support such as insurance or property level flood protection also have a role to play. We need a blend of the two.
• The importance of involving communities in decision-making People living in social and economic disadvantage often feel they have less power and influence to inform decisions about their community. This may include decisions which support their ability to adapt to climate change such as local development planning, coastal management or housing rights. Empowering communities to be involved in locally led adaptation is essential for achieving the right to health; it is also integral to creating more progressive, transformational approaches to climate adaptation which will require changes across society. At Sniffer we have made some steps towards creating accessible ways for people to get involved in locally led adaptation including developing a community adaptation routemap through the Adaptation Scotland programme, working with Public Health Scotland, Architecture and Design Scotland, the Scottish Government, the Sustainable Scotland Network and EKOS to develop the place standard through a climate lens tool and testing different participatory mapping activities and an adaptation personas tool across a range of Adaptation Scotland projects.
• Climate and public health professionals can benefit hugely from working together. Addressing climate change and working to reduce health inequalities are two massively challenging agendas with different skills and terminology. It’s easy to understand why professionals working in these disciplines might struggle to find the time to work together or be overwhelmed with adding yet more complexity. The good news is that there are now more resources than ever available to support interdisciplinary working including free online courses from Public Health Scotland where you can learn about the building blocks of good health. You can also use Health Impact Assessment guidance to consider the implications of climate resilience plans and action across population groups and on the economic, social and environmental determinants of health and health outcomes.

My hope is that the briefing will open a new conversation on how health inequalities can be addressed as an integral part of Scotland’s approach to climate resilience and just transition policy, planning and action. Take a look at the briefing and share your feedback, challenges and ideas with us.

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The Adaptation Scotland programme is delivered by Sniffer and funded by the Scottish Government