Constraints and Barriers to Public Health Adaptation to Climate Change
A Review of the Literature
Cunrui Huang, MSPH, MMed, Pavla Vaneckova, PhD, Xiaoming Wang, PhD,
Gerry FitzGerald, PhD, Yuming Guo, MMed, Shilu Tong, PhD
心得
1.面對氣候變遷，在公共衛生上要努力的方向有二，一是增加健康適應能力，二是實施適應行動。而實施的障礙因素很多，如對未來氣候不確定性和社會經濟條件，以及金融，科技，機構處理，社會資本和個人認知的限制。
但個人的健康適應力的組成及影響因素及如何有效的測量個人的健康適應能力，是我們所需思考的
2.其所定義的公共健康適應是指一種策略，一種減少氣候變遷對健康影響或增加對氣候變化的應變能力，但是如果將定義轉換在對環境與自身身體變化的個人健康適應，定義就可以改寫為，個人健康適應是指一種策略，一種減少環境變化及自身身體變化對健康影響或增加對環境變化及自身身體變化的應變能力的策略。
3.此段說明氣候變化的不確定性加深各國政府應付氣候變遷的困難性，在人口，社會經濟和科技等條件不同下，更是難以預測。
此外弱勢族群適應能力是最少，而能力高低的分配範圍是制定政策的困難之處。
4.此段說明科技在氣候變遷的健康適應的應用上也有所所限制，雖然科技的應用是適應能的的重要決定因素，店但是科技的應用也有氛所限制，1.其需要大量的技術、知識、資金。2.受到氣候變化的人是否能使用已存的科技是一個挑戰。3.如網路的使用，是在收入，教育，年齡和種族是有落差的，原因是他們被負擔能力與技能所限制。
此段將科技視為解決適應問題的重要手段，這點可成為參考文獻，這也說明科技的使用是有障礙性，由其是弱勢的老人低收入低教育程度。
5.此段說明健康組織或機構對因氣候變遷所健康要的健康適應與適應行為，機構的困難之處，首先很少政府有專責機構來制定相關政策與研究適合的適應行動，其次是資訊的提供，尤其是帶有行動指導的資訊，這資訊若是一種不充份的適應方案或預期成本超出預期的收益，決策者可能決定不調整，或推遲他們的適應行動。
6."屬於一個社會網絡可以有一定的保護作用對熱相關的疾病。與此相反，低層次的社會資本被視為塑造脆弱的群體，即被排除在獲取資源之外或適應的決策過程並無相關資源可進行參考。"可以想像的是高的社會資本的人資訊的來源與接收是比低社會資本的人來的多且迅速，但是過多的健康資訊會造成資訊過載，也可能無益於健康適應。所以資訊量的多寡並非以線性的方式來影響健康適應，是什麼樣的曲線關係，應是值得探究。
其次本段亦點出公共健康適應與社會資本之間關係研究的不足，而個人的健康適應與社會資本的研究更是如此。
7.此段說明一個人在認知與意識上不足，即會影響其決策或行為，而資訊的有無，並非行為結果正確與否的關鍵，而是取決於知識與意識的充足與否，熱浪的警訊即是一例，可能的因素是這些適應能力較差的人，除了知識與意識不充足之外，自覺能力不足，或過於自信，也是因素之一。
Abstract:
Public health adaptation to climate change is an important issue and inevitably is needed to address the adverse health impacts of climate change over the next few decades.
This paper provides an overview of the constraints and barriers to public health adaptation and explores future research directions in this emerging fıeld.
An extensive literature review was conducted in 2010 and published literature from 2000 to 2010 was retrieved.
This review shows that public health adaptation essentially can operate at two levels, namely, adaptive-capacity building and implementation of adaptation actions.
However, there are constraints and barriers to public health adaptation arising from uncertainties of future climate and socioeconomic conditions, as well as fınancial, technologic, institutional, social capital, and individual cognitive limits.
The opportunities for planning and implementing public health adaptation are reliant on effective strategies to overcome these constraints and barriers.
It is proposed here that high research priority should be given to multidisciplinary research on the assessment of potential health impacts of climate change, projections of health impacts under different climate and socioeconomic scenarios, identifıcation of health cobenefıts of mitigation strategies, and evaluation of cost-effective public health adaptation options.
摘要：
公共衛生適應氣候變化是一個重要的問題，必然是需要解決的不利健康影響的氣候變化在未來幾十年。
本文提供了一個概述的限制和障礙，以適應市民的健康，並探討今後的研究方向在這一新興領域。
大量文獻進行了回顧，2010年出版的文獻2000至2010年被檢索。
這個審查表明，基本上可以適應公共衛生工作在兩個層次，即自適應能力建設和實施適應行動。
但是，也有限制和障礙，以適應市民的健康所產生的不確定性對未來氣候和社會經濟條件，以及金融，工藝，機構，社會資本和個人認知的限制。
的機會規劃和實施公共衛生適應是依賴於有效的策略，以克服這些制約因素和障礙。
它建議在這裡，高優先研究應給予多學科的研究評估潛在的健康影響氣候變化，預測了在不同氣候對健康的影響和社會經濟情況，確定健康cobenefıts緩解戰略和評價成本效益公共衛生適應辦法。
面對氣候變遷，在公共衛生上要努力的方向有二，一是增加健康適應能力，二是實施適應行動。而實施的障礙因素很多，如對未來氣候不確定性和社會經濟條件，以及金融，工藝，機構，社會資本和個人認知的限制。
All people will be exposed to the potential impacts of climate change, but some populations may be more vulnerable.
The vulnerability depends on the level of exposure, population sensitivity, and adaptive capacity.
The health impacts will dependon the rate and magnitude of changes in climate; on the social, economic, demographic, infrastructural, and other factors that can influence the sensitivity of populations to climate change; and on the adaptive capacity to manage the health effects of climate change.
所有的人都將面臨的潛在影響氣候變化，但有些人群可能更容易受到攻擊。
該漏洞取決於暴露的水平，人口靈敏度和適應能力。
對健康的影響將 dependon的速度和幅度的氣候變化，對社會，經濟，人口，基礎設施，以及其他因素，可以影響靈敏度的人群氣候變化的適應能力和管理氣候對健康的影響改變。
面對氣候改變的適應力的不同，使低適應力的人會因氣候變遷而生病或死亡。
Public Health Adaptation
Generally, public health adaptation is considered as any short- or long-term strategies that can reduce adverse health impacts or
enhance resilience in response to observed or expected changes in climate and associated extremes.
公共衛生適應
一般來說，公共衛生適應被認為是任何短期或長期的策略，可以減少不良健康影響或增強應變能力應對觀察到的或預期的氣候變化及相關極端。
所以其所定義的公共健康適應是指一種策略，一種減少氣候變遷對健康影響或增加對氣候變化的應變能力，但是如果將定義轉換在對環境與自身身體變化的個人健康適應，定義就可以改寫為，是指一種策略，一種減少環境變化及自身身體變化對健康影響或增加對環境變化及自身身體變化的應變能力。
Technologic Limits
Technology potentially can play an important role in adapting to climate change.
Access to, and use of, technology usually is regarded as an important determinant of adaptive capacity.
There have been successful applications of new technologies in the public health area to adapt to observed and anticipated climate change.
GISs and remote-sensing data are becoming useful assessment tools, and such technologies can help health professionals to reallocate resources and reduce risks.
However, conditions for the creation of new technology require access to expertise, knowledge, and funding.
Even though some technologies already exist, it is also a challenge to make those technologies accessible to populations who will be most affected by climate change.
For example, the Internet is a powerful communication tool and is an important source of information to address the health impacts of climate change.
Nevertheless, studies show that substantial disparities exist in Internet adoption within and among countries, with these disparities linked to income, education, age, and ethnicity.
Because of major affordability and skill limitations, it is diffıcult to bring the Internet to rural and remote areas, particularly in developing countries.
Technologic限制
技術可能可以發揮重要作用，適應氣候變化。
訪問和使用，技術通常被視為一個重要的決定因素的適應能力。
也有成功應用的新技術在公共衛生領域，以適應觀察和預期的氣候變化。
的GIS和遙感數據成為有用的評估工具，這些技術可以幫助醫療人員重新分配資源，減少風險。
不過，條件的創造新的技術需要獲得專業技能，知識和資金。
即使有些技術已經存在，它也是一個挑戰，使這些技術誰接觸到的人群將受到氣候變化影響最大。
舉例來說，互聯網是一個強大的通訊工具，是一個重要的信息來源，以解決氣候變化對健康的影響。
然而，研究表明，大量存在的差距在Internet通過內部和國家之間，這些差距與收入，教育，年齡和種族。
由於主要的負擔能力和技能的限制，很難把互聯網向農村和偏遠地區，特別是在發展中國家。
此段說明科技在氣候變遷的健康適應的應用上也有所所限制，雖然科技的應用是適應能的的重要決定因素，店但是科技的應用也有氛所限制，1.其需要大量的技術、知識、資金。2.受到氣候變化的人是否能使用已存的科技是一個挑戰。3.如網路的使用，是在收入，教育，年齡和種族是有落差的，原因是他們被負擔能力與技能所限制。
Uncertainties of Future Climate and Socioeconomic Conditions
Public health adaptation decisions are made in a context of uncertain and dynamic environments.
Although it is very likely that the global climate will change, there are still uncertainties about how it will change and how fast.
In order to address the climate change due to increasing GHG emissions, the IPCC defıned a set of 40 scenarios.
Each scenario makes different assumptions for future GHG emissions, land use, and other driving forces.
To project spatially dependent climates in the future under various emissions scenarios, various General Circulation Models have been developed based on physical principles at the continental scale.
However, because different models use different plausible representations of the climate system, climate projections for a single scenario can differ, creating more uncertainties.
In addition to the uncertainties in climate projections, diffıculties also rise from uncertainties of future demographic, socioeconomic, and technologic conditions that will change the exposure, sensitivity, and adaptive capacity of populations.
For example, there are uncertainties regarding the future populations at risk and future sensitivity to climate change.
Even though the future population stratifıed by age could be estimated reasonably, trends in education levels, fınancial situation, and levels of racial diversity and acclimatization within each age group are very hard to predict.
Thus, an inherent challenge for public health adaptation is the handling of uncertainties about the future health impacts of climate change.
Financial Challenges Managing the health effects of climate change can be costly.
Billions of dollars are likely to be required every year to meet the challenges in the near future.
However, the countries that are most severely affected by climate change are often those most under-resourced.
Furthermore, within each country, the poorest groups in a society have the least capacity to adapt.
The distribution of adaptive capacity within and across societies represents a major barrier to the effectiveness of any adaptation strategy.
This barrier will likely exacerbate existing health inequalities as well as the underlying social determinants of illness and premature death, which largely limits the ability of disadvantaged people to take actions to adapt to climate change.
In the developed countries, there is also a problem of funding insuffıciency to address the health impacts of climate change.
For example, Ebi et al. argued that the NIH and other government agencies need to have robust programs to meet the challenges in the U.S., with annual funding of more than $200 million per year.
However, the funding assigned to directly addressing the health impacts of climate change has been less than $3 million,creating a large fınancial gap.
Bedsworth conducted a survey to examine how local health agencies in California are prepared for dealing with the potential risks of climate change.
Most local health offıcers responded that they have inadequate resources.
Likewise, Olaris suggested that funding was the main barrier for the health sector to tackle climate change in Victoria, Australia.
Hence, in the absence of governmental prioritization of climate change impacts on health, fınancial resources are likely to remain
a substantial barrier to public health adaptation.
不確定性的未來氣候和社會經濟條件
公共衛生適應決定在上下文環境中的不確定和動態。
雖然它很可能是全球氣候將發生變化，仍存在不確定性將如何改變和有多快。
為了應對氣候變化，由於溫室氣體排放量增加，警監會定義一組 40的情景。
每個方案使得不同的假設對未來溫室氣體排放，土地利用，和其他驅動力。
項目空間相關的氣候在未來的各種排放情景下，不同的大氣環流模型已經開發了基於物理原理在大陸的規模。
但是，由於不同型號使用不同的合理意見的氣候系統，氣候預測的一個場景可能不同，創造更多的不確定性。
除了氣候預測的不確定性，困難也隨之上升，從未來的不確定性的人口，社會經濟和technologic條件，改變曝光，靈敏度和適應能力的人群。
例如，有對未來的不確定性風險，人口在未來氣候變化的敏感性。
即使未來人口按年齡分層可合理估計，趨勢教育水平，財務狀況和水平的種族多樣性和馴化在每個年齡組都很難預測。
因此，一種內在的挑戰，對公眾健康適應是處理不確定性對未來健康的影響氣候
改變。
財務管理面臨的挑戰對健康的影響氣候變化可能是昂貴。
數十億美元有可能被要求每年迎接挑戰，在不久的將來。
然而，最嚴重的國家，受氣候影響
改變往往是那些最不足的資源。
此外，在每一個國家，一個社會最貧困群體的適應能力是最少。
分佈範圍內的適應能力和整個社會是一個重大障礙的有效性的任何適應戰略。
這個障礙很可能會加劇現有的衛生不平等，以及潛在的社會決定因素的疾病和過早死亡，這在很大程度上限制了能力的弱勢群體採取行動，以適應氣候變化。
在發達國家，也有一個問題，以解決資金不足對健康的影響氣候變化。
例如，EBI等。認為，美國國立衛生研究院和其他政府機構需要有強大的方案，以迎接挑戰，在美國，每年撥款超過 2萬個年。
然而，資金分配，直接解決氣候變化對健康的影響已不到300萬美元，建立一個龐大的資金缺口。
Bedsworth進行了一項調查，以研究如何在加州當地衛生部門正在準備處理可能出現的風險的氣候變化。
大多數地方衛生官員答复說，他們沒有足夠的資源。
同樣，Olaris建議，資金的主要障礙為衛生部門應對氣候變化在澳大利亞維多利亞州。
因此，在缺乏政府的優先次序的氣候變化對健康，財力可能保持
實質性的障礙公共衛生適應。
此段說明氣候變化的不確定性加深各國政府應付氣候變遷的困難性，在人口，社會經濟和科技等條件不同下，更是難以預測。
此外弱勢族群適應能力是最少，而能力高低的分配範圍是制定政策的困難之處。
Institutional Arrangements
Institutions refer to the formal and informal rules as well as organizational arrangements governing human interactions.
Public health adaptation to climate change demands political action and social mobilization, so there is an important role for institutions in facilitating adaptation.
However, the current institutional arrangements seem unlikely to ensure an effective, effıcient and equitable adaptation strategy.
Governments are typically organized in specialized policy domains.
Fragmentation and policy contradictions are often a serious problem at all levels of government.
Given the complexity of health impacts of climate change, it is diffıcult to catalog all adaptations taking place.
This is complicated particularly by the fact that, currently, in many countries there is no lead agency responsible for public health adaptation.
In addition, knowledge about what adaptation actions to take, coupled with a high degree of adaptive capacity, may not automatically translate into successful adaptations.
Climate change may be perceived as posing little risk compared with other health hazards and therefore be given low priority by decision makers.
In 2007, Maibach et al. conducted a telephone survey with 133 randomly selected local health department directors in the U.S.
The results suggested that a majority of respondents felt that climate change was likely to become an increasing problem in the coming decades in their jurisdiction; however, only a few had made climate change one of the priorities of their departments.
Moreover, effective adaptation requires information about what actions are possible to address the impacts.
Yet there is a paucity of knowledge about the potential effectiveness of different adaptation options and their costs.
Typically, evaluation of particular adaptation options should compare the benefıts with the costs, and the options that are chosen should be the ones that yield the highest net benefıt.
Otherwise, if information on adaptation options is inadequate or their expected costs go beyond the expected benefıts, decision makers may decide not to adapt, or to delay their adaptation actions.
制度安排
機構指的是正式和非正式的規則以及組織安排治理人類的相互作用。
公共衛生適應氣候變化的需求的政治行動和社會動員，所以有一個重要的角色機構在促進適應。
然而，目前的制度安排似乎不太可能，以確保有效和公平的適應戰略。
各國政府通常是組織專門的政策領域。
碎片和政策的矛盾往往是嚴重的問題在各級政府。
由於複雜的氣候變化對健康的影響，也很難適應正在發生的所有目錄。
這是複雜的，特別的是，目前，在許多國家，沒有領導機構負責公共衛生適應。
此外，知識什麼行動，採取適應，再加上高度的適應能力，可能不會自動轉化為成功的適應。
氣候變化可能被視為構成小的風險比其他健康危害，因此，給予低優先級的決策者。
2007年，Maibach等。進行了一項電話調查，以隨機抽取133當地衛生部門的董事在美國
結果表明，多數的受訪者認為，氣候變化很可能會成為一個日益嚴重的問題在今後幾十年在其管轄範圍，但是，只有少數取得了氣候變化的優先事項之一的部門。
此外，有效的適應需要的信息可能採取哪些行動，以解決影響。
然而，有一個缺乏知識的潛在效益不同的適應方案及其成本。
通常情況下，特別是適應選項評估應該比較利益與成本，以及選項的選擇應該是那些產量最高的淨效益。
否則，如果信息是不充分的適應方案或他們的預期成本超出預期的收益，決策者可能決定不調整，或推遲他們的適應行動。
此段說明健康組織或機構對因氣候變遷所健康要的健康適應與適應行為，機構的困難之處，首先很少政府有專責機構來制定相關政策與研究適合的適應行動，其次是資訊的提供，尤其是帶有行動指導的資訊，這資訊若是一種不充份的適應方案或預期成本超出預期的收益，決策者可能決定不調整，或推遲他們的適應行動。
Social Capital
It has been claimed that the theoretic underpinning of public health adaptation lies in the concept of social capital, which enables residents to coordinate community actions to achieve shared goals.
A high level of social capital will support collective initiatives of adaptation and also enhance resilience.
Research in Chicago suggests that belonging to a social network can have a protective effect against heat-related illness.
By contrast, a low level of social capital is regarded as shaping the vulnerability of population groups who are excluded from access to resources or decision making in the adaptation process.
However, Wolf et al. indicate that strong bonding networks also could exacerbate rather than reduce vulnerability to the effects of climate change.
The authors suggested that misperceptions by the elderly and their social contacts about the health risks from heatwaves were an example of a barrier to proactive adaptation.
Accordingly, public health adaptation may not always be able to rely on effıcacy in existing social networks in response to climate change.
Because social capital barriers to public health adaptation have not been well researched so far, it is still unclear in which conditions social capital may be counterproductive and even increase vulnerability.
社會資本
它一直聲稱的理論基礎公共衛生適應在於觀念的社會資本，使社區居民協調行動，以實現共同的目標。
一個高層次的社會資本將支持集體行動的適應和應變能力也增強。
研究表明，在芝加哥，屬於一個社會網絡可以有一定的保護作用對熱相關的疾病。
與此相反，低層次的社會資本被視為塑造脆弱的群體誰被排除在獲取資源或決策的適應過程。
不過，沃爾夫等人。表明，粘結力強網絡也可能會加劇而不是減輕易受氣候變化的影響。
作者認為，誤解長者及他們的社會交往帶來的健康風險熱浪是一個例子，以主動適應的障礙。
因此，公共衛生適應未必總是能夠依靠現有的社會網絡中的療效在應對氣候變化。
由於社會資本障礙公共衛生適應沒有得到很好的研究，到目前為止，還不清楚它是在什麼條件下社會資本可能會適得其反，甚至增加脆弱性。
"屬於一個社會網絡可以有一定的保護作用對熱相關的疾病。與此相反，低層次的社會資本被視為塑造脆弱的群體，即被排除在獲取資源之外或適應的決策過程並無相關資源可進行參考。"可以想像的是高的社會資本的人資訊的來源與接收是比低社會資本的人來的多且迅速，但是過多的健康資訊會造成資訊過載，也可能無益於健康適應。所以資訊量的多寡並非以線性的方式來影響健康適應，是什麼樣的曲線關係，應是值得探究。
其次本段亦點出公共健康適應與社會資本之間關係研究的不足，而個人的健康適應與社會資本的研究更是如此。
認知的限制
public health adaptation to climate change can be
limited by human cognition.
An individual’s knowledge of climate change is necessary but insuffıcient for adaptation.
Perceptions of risk, vulnerability, and adaptive capacity will also affect decision making or behavioral change.
For example, the public may know when a heatwave will occur, but they may not think they are vulnerable to the impacts.
Higher-income earners may perceive a lower risk from climate change because they have the fınancial means to cope with the threats.
Individual interpretation of information can be influenced by personal experience, values, priorities, and other contextual factors.
Sheridan conducted a telephone survey of public perception and response to heat warnings across four North American cities during the summers of 2004 and 2005.
Among respondents with advanced age or chronic illness, 60% of them reported that they did not perceive themselves to be at risk from the health effects of heat.
Further, relatively few respondents reported taking preventive actions because of the heat event.
An interview-based study of older people in London and Norwich also confırmed these similar fındings.
Hence, even with the most sophisticated warning system available, the system will be less effective if the public are not motivated to respond.
最後，公共衛生適應氣候變化，可
受限於人類的認知。
一個人的知識，氣候變化是必要的，但不夠適應。
知覺風險，脆弱性和適應能力也將影響決策或行為的改變。
例如，市民可知道何時會出現熱浪，但他們可能不認為他們很容易受到影響。
高收入者可能會認為風險較低的氣候變化，因為他們有財力，以應付威脅。
個人解釋信息可能會受到個人的經驗，價值觀，優先事項，以及其他相關因素。
謝裡丹進行了一項電話調查的公眾認知和反應熱的警告在四個北美城市在2004年和2005年的夏天。
在受訪者年齡與先進或慢性疾病，其中60％表示他們不認為自己處於危險的健康影響的熱量。
此外，受訪者相對較少採取預防措施，因為熱事件。
面試為基礎的研究老年人在倫敦和諾里奇也證實了這些類似的結果。
因此，即使是最先進的預警系統可用，系統就會事倍功半，如果市民不積極回應。
此段說明一個人在認知與意識上不足，即會影響其決策或行為，而資訊的有無，並非行為結果正確與否的關鍵，而是取決於知識與意識的充足與否，熱浪的警訊即是一例，可能的因素是這些適應能力較差的人，除了知識與意識不充足之外，自覺能力不足，或過於自信，也是因素之一。
