Exploring the health context : a multimethod approach to climate change adaptation evaluation

Climate change is a major environmental Public Health issue of the 21st century. Extreme heat and cold, weather events such as flooding or storms, disease vector distribution changes, and increased pathogen loads in water might all put human health at risk. To protect health from inevitable changes, climate change adaptation strategies are implemented at local, national, and global level. Are these measures effectively reducing health risks? This dissertation explores multiple methods to evaluate climate change adaptation to increase our understanding of the contextual requirements for measurement of effects. Health-related climate change adaptation is situated within theories of place and placebased vulnerability. Targeting two core research questions on effectiveness of adaptation and on useful approaches to evaluation, this mixed methods work combines a systematic review, policy analysis, risk factor modeling, situational analysis, and theoretical framework development on cases from Europe and Japan. The systematic review on effectiveness of heat adaptation showed challenges concerning attributing health outcomes directly to specific adaptation measures via epidemiological methods. Without conclusive evidence for individual adaptation items, emphasis instead is placed on policy evaluation, on risk factor distribution changes, and on local or on the ground adaptation. The data suggest that reframing effectiveness towards inequality and vulnerability reduction is a promising strategy for evaluation while dealing with gaps in the causal chains between adaptation and health outcomes. Based on these findings, I argue that adaptation evaluation in Public Health could apply a portfolio of methods and theory-based solutions informed by structural prevention measures, qualitative methods such as context mapping, and transformation as a philosophy of change. Most importantly, a conceptual re-thinking of adaptation evaluation is suggested that positions social justice and place-based vulnerability concepts as imperatives for successful adaptation.