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23/145 Climate change and health

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Published: 07 November 2023

Version: 1.0 October 2023

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Research question

  • What are the impacts of local authority led interventions aimed at climate change mitigation and/or adaptation on health and inequalities?

Climate change has been identified as the biggest threat to population health of the 21st century by the World Health Organization. In the UK, the health consequences of climate change are both direct, such as deaths related to heatwaves, floods or other extreme weather events, and indirect, for instance due to food and fuel insecurity caused by disruption of supply chains. On the other hand, climate change is the greatest opportunity to redefine the social and environmental determinants of health. Many interventions that reduce greenhouse gas emissions have health co-benefits, such as promoting physical activity by increasing active travel, and reducing air pollution exposure by switching to green energy sources. Nature-based solutions to increase carbon capture and reduce biodiversity loss also contribute to reducing air pollution and promote exposure to nature, which has benefits for mental and physical health.

Local authorities can take actions that change their impact on the climate and can also take actions that mitigate the impacts of climate change on their population.

Climate change has been described as a threat multiplier as it exacerbates the pre-existing health inequalities. In addition, the communities that contribute the least to our greenhouse gas emissions, such as those experiencing deprivation, are the most vulnerable to the detrimental impact of climate change in the UK. Therefore, interventions that mitigate the impact of climate change have the potential to reduce health inequalities by reducing risk factors that are more prevalent among disadvantaged groups. However, population groups who are likely to experience the most severe impact of climate change are the least likely to engage due to tangible and intanglible barriers.

Although central governments have a key role to play in developing policies that allow us to decarbonise our economies and adapt to climate change, many of these policies need to be implemented at local level. This call looks at the whole remit of local government, such as:

  • transport
  • planning
  • housing
  • green and blue space management
  • local food systems

The importance of action led by local authorities and involving communities has been recognised by the UK Climate Change Committee as essential to meet net zero commitments. Climate interventions are often intersectoral and multidisciplinary and have positive and negative outcomes across a variety of areas, including health, and over different time scales. On one hand, implementation and evaluation of these interventions presents challenges to current methods and frameworks. On the other hand, how policy makers and the public understand, accept and value the trade-offs between different outcomes, particularly those related to health, remains unclear.

Research areas of interest

Research areas of interest for this call could include (but are not limited to):

  • evaluations or modelling of the impact on health, including health inequalities, of:
    • Local Authority actions to reduce organisational impact
    • Local Authority actions to mitigate impacts of climate change
  • health economic evaluations, or modelling, of:
    • Local Authority actions to reduce organisational impact
    • Local Authority actions to mitigate impacts of climate change
  • evaluation of interventions acting on the acceptability, to the public, of climate change actions, particularly in under-served groups

Evaluations of interest

Evaluations of interest would include investigations of:

  • the barriers and facilitators of local interventions that focus on climate change and impact health
  • how local level interventions can be scaled up to national level
  • how behaviour change theories can be used to drive the behaviour changes required to reduce greenhouse gas emissions
  • barriers and facilitators for engagement with climate related interventions for different population groups, particularly those who experience health inequalities
  • the health and non-health-related costs and benefits of investing in climate change mitigation and adaptation activities by local authorities
  • the the short-, medium-, and long-term budgetary implications of climate change mitigation and adaptation activities for local authorities
  • how the costs and outcomes are distributed across the population using distributional cost-effectiveness analysis
  • similarities and differences in perceptions and understandings of climate change and health across communities with a range of cultural and socio-economic backgrounds
  • the effectiveness of community engagement in this area
  • the role of perceptions of “fairness” in public acceptability

Study designs

A range of study designs and outcome measures can be used. Researchers will need to identify and justify the most suitable methodological approach. Researchers will also need to specify key outcomes and how these will be measured in the short, medium and long term. Researchers are encouraged to use the validated implementation outcomes, i.e:

  • acceptability
  • adoption
  • appropriateness
  • costs
  • feasibility
  • fidelity
  • penetration
  • sustainability

These outcomes should be evaluated using evidence-based methods and instruments as recommended in the Implementation Outcomes Repository. Acknowledging the long time scales of climate related interventions, intermediary and proxy outcomes are accepted if appropriately justified.

Considering the intersectoral nature of climate change mitigation and adaptation, applications that involve multidisciplinary teams, including partners from non-health backgrounds, are encouraged.

Providing value to the economy and community

Understanding the value of public health interventions - whether the outcomes justify their use of resources - is integral to the PHR Programme, where resources relating to different economic sectors and budgets are potentially relevant. The main outcomes for economic evaluation are expected to include health (including health-related quality of life) and the impact on health inequalities as a minimum, with consideration of broader outcomes welcomed. Different approaches to economic evaluation are encouraged as long as they assess the value and distributive impact of interventions. Applications that do not include an economic component should provide appropriate justification. The PHR Programme expects researchers to carefully define and justify the choice of the population being studied and how demographic variations at local levels will be accounted for. 

The PHR Programme is predominantly interested in the evaluation of interventions operating at a population level rather than at an individual level and which should address health inequalities and the wider determinants of health. The PHR Programme recognises that interventions are likely to impact different (sub)populations in different ways, and encourages researchers to explore such inequalities of impact in their study design. Of particular importance to the PHR Programme is an understanding of inequalities in impact of policy and access to services by people experiencing socioeconomic disadvantage and those from ethnic minority backgrounds in the UK. Evaluations of interventions seeking to reduce health inequalities experienced by these groups are also of specific interest to the PHR Programme.

The PHR Programme welcomes involvement from the target population groups and relevant organisations in the design of the evaluation and in the research team. We will consider inclusion of experts as costed members of the study team if appropriately justified. Researchers should demonstrate the relevance of their proposed research to key stakeholders including local and national policy makers, service users, designers and service providers. Researchers are encouraged to develop links and networks with other sectors. Researchers are also expected to be aware of other studies in this area and ensure their proposed research is complementary.  

Further information

It is important to be aware that Climate Change Hubs are in the process of being funded by NIHR, UKRI and DHSC. Successful applicants to this call will be encouraged to make contact with these hubs once they are developed.

For further information on submitting an application to the PHR Programme, please refer to the Stage 1 guidance notes and PHR supporting information.