Not what the doctor ordered: Prioritizing transdisciplinary science on climate, environment and health in the Latin American and Caribbean region

Climate change adaptation responses are being developed and delivered in many parts of the world in the absence of detailed knowledge of their effects on public health. Here we present the results of a systematic review of peer-reviewed literature reporting the effects on health of climate change adaptation responses in low- and middle-income countries (LMICs). The review used the ‘Global Adaptation Mapping Initiative’ database (comprising 1682 publications related to climate change adaptation responses) that was constructed through systematic literature searches in Scopus, Web of Science and Google Scholar (2013–2020). For this study, further screening was performed to identify studies from LMICs reporting the effects on human health of climate change adaptation responses. Studies were categorised by study design and data were extracted on geographic region, population under investigation, type of adaptation response and reported health effects. The review identified 99 studies (1117 reported outcomes), reporting evidence from 66 LMICs. Only two studies were ex ante formal evaluations of climate change adaptation responses. Papers reported adaptation responses related to flooding, rainfall, drought and extreme heat, predominantly through behaviour change, and infrastructural and technological improvements. Reported (direct and intermediate) health outcomes included reduction in infectious disease incidence, improved access to water/sanitation and improved food security. All-cause mortality was rarely reported, and no papers were identified reporting on maternal and child health. Reported maladaptations were predominantly related to widening of inequalities and unforeseen co-harms. Reporting and publication-bias seems likely with only 3.5% of all 1117 health outcomes reported to be negative. Our review identified some evidence that climate change adaptation responses may have benefits for human health but the overall paucity of evidence is concerning and represents a major missed opportunity for learning. There is an urgent need for greater focus on the funding, design, evaluation and standardised reporting of the effects on health of climate change adaptation responses to enable evidence-based policy action.

Global sustainability challenges and their impact on society have been well-documented in recent years, such as more intense extreme weather events, environmental degradation, as well as ecosystem and biodiversity loss. These challenges require a united effort of scientists from multiple disciplines with stakeholders, including government, non-government organizations, corporate industry, and members of the general public, with the aim to generate integrated knowledge with real-world applicability. Yet, there continues to be challenges for these types of collaboration. In this commentary, we describe processes of collective un learning that serve to de center academia in collaborations leading to a more equitable positioning of practitioners engaged in collaborative global sustainability research. Increasing attention to transdisciplinary (TD) sustainability science has shaped the joint work of researchers and practitioners currently addressing pressing global sustainability problems. In this short commentary, we describe and discuss an international TD collaboration and draw upon the authors’ experiences after 5 years of ongoing collaborative work in the realm of global sustainability research in the Americas. Our collective experience illustrates that processes of un learning serve to de center academia in TD collaborations leading to a more equitable positioning of practitioners engaged in TD research. Participating in social un learning practices that aim to deconstruct and disrupt institutionalized scientific norms and challenge entrenched institutional structures may hold the key to mobilizing TD research for solution-oriented placed-based social-ecological research.