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Climate-Resilient and Sustainable Health Systems: An Emerging Space for New Voices in Health Policy and Systems Research

This post was originally shared on Speaking of Medicine and Health, and was written by guest contributors Renzo R. Guinto (Section Editor for PLOS Global Public Health’s Planetary and Environmental Health Section), Revati Phalkey, Upasona Ghosh, Shibaji Bose

For many years, climate change has not been a major focus of the international health policy and systems research (HPSR) community. In fact, during the 5th Global Symposium on Health Systems Research organized by Health Systems Global (HSG) in Liverpool in 2018, only one abstract out of thousands mentioned the phrase “climate change.” But there is no denying that the climate emergency is already posing an existential threat – while COVID-19 is wreaking its own havoc – to population health and health systems worldwide, as summarized in the “code red” assessment of the recent reports of the UN Intergovernmental Panel on Climate Change (IPCC) and the Lancet Countdown. Hence, the HPSR community cannot anymore turn a blind eye to this pressing planetary health challenge.

But the HPSR community is now stepping up. This year, we, a group of scholars and practitioners deeply concerned about the nexus of climate change and health systems, started a new Thematic Working Group in HSG – TWG on Climate-Resilient and Sustainable Health Systems, which was officially launched at the recently concluded UN Climate Change Conference (COP26) in Glasgow. In the coming years, we hope to facilitate learning and knowledge exchange, advance frameworks and research methods, and build technical capacity especially among the next generation of scholars and practitioners – all for the advancement of scholarship and practice around the climate change and health systems interface. To jumpstart this work, our TWG organized a panel discussion on November 27, 2021 at the face-to-face training of the Emerging Voices for Global Health, which is one of HSG’s flagship programs. Below are five key messages that emerged from the discussion.

First, climate change is already affecting every part of the world – whether poor or rich. It is not just an issue for low- and middle-income countries (LMICs), such as the Philippines being hit by severe typhoons or India experiencing droughts that worsen undernutrition. Even high-income countries are already being impacted by climate change today, such as Canada being struck by heat waves or Germany being affected by extreme flooding which is unprecedented in the country’s history. Hence, HPSR researchers and practitioners from countries rich and poor alike can truly collaborate on the climate-health systems nexus, and knowledge, expertise, and solutions can flow bidirectionally. For instance, Renzo is launching a collaboration between the Philippines and the University of California San Francisco on building climate-resilient local health systems – both the Philippines and United States have something to learn from each other in this novel arena.

Second, tackling the climate-health systems nexus means that the focus cannot only be about health systems but also the broader environment. The boundaries of investigation become blurred, and the scope of inquiry keeps on expanding. To truly understand this interface, we must study not only health systems but also social and ecological systems and their interconnections. In HPSR we always say we embrace transdisciplinarity – but studying climate change means we need to work with unconventional allies such as climatologists, ecologists, and geologists, among others. One example where HPSR practitioners are engaging with other disciplinary experts such as natural scientists, environmentalists, and gender scholars is the international consortium TAPESTRY, which focuses on climate change transformation in marginalized environments in India and Bangladesh. Upasona has been working with this consortium which investigates the experiences of different actors in dealing with climate change and how the co-produced knowledge can help transform a community’s wellbeing in the face of the climate crisis.

Third, climate change does not only affect health system functions but directly impacts communities themselves by operating through their context-specific social determinants of health. Hence, HPSR work on climate change cannot ignore communities that are in the frontlines of the climate crisis and that are usually neglected in traditional health system frameworks that tend to focus on “building blocks” or “control knobs.” Special attention must be given to meaningful and respectful engagement with indigenous communities. For instance, in the Indian part of Sundarbans which is one of the world’s climate change hotspots, the space for community participation in health decision-making is limited. Shibaji and Upasona utilized an action research technique, photovoice, to provide mothers of young children with a platform to express their collective voices about how climate change is impacting their children’s health. In the project, women participating as co-researchers negotiated with local policymakers to take mutually agreeable actions at the community level.

Fourth, climate change is already experienced by everyday people; its impacts are graphic and cannot be merely represented in numbers or interview transcripts. Hence, the climate-health systems nexus presents a unique opportunity to employ a wide range of innovative research and communication techniques. For instance, the photovoice project in the Indian Sundarbans earlier described has been documented in film, communicating the interplay of shared contextual and differential vulnerabilities faced by children and how these exacerbate their experience of climate change. The film version of Renzo’s doctoral dissertation on climate-smart local health systems in coastal municipalities in the Philippines captured not the expert voice but the voices of frontline communities; his films have been used as teaching material and viewed by tens of thousands from around the world. Participatory visual action research methods also act as a route to surfacing knowledge around health systems uncertainty as well as a platform for enabling communities to become active agents in knowledge making, shifting the politics of research.

Fifth, climate change is an issue that is not just urgent but also has a strict deadline and hard limits that are of lasting consequence to humanity – keeping the global average temperature increase below 1.5 degrees Celsius by 2030 as articulated in the Paris Agreement and reinforced by the Glasgow Pact.Lives are at stake – not just of people in the present but of the future children of the world. Hence, the climate-health systems nexus requires not just rigorous scholarship but bold activism and movement building. The COVID-19 pandemic and the vaccine inequity it generated compelled many global health and HPSR researchers and practitioners to embrace activism – the same must happen in relation to the evolving climate emergency. The HPSR community must feel impatient about the slow pace of climate action which has huge long-term negative consequences for health system resilience and health equity. Therefore, immediate translation of newly generated knowledge on this nexus through rapid dissemination to policymakers, practitioners, and the public is of paramount importance.

At COP26, more than 50 countries made a commitment to build climate-resilient and low-carbon national health systems in the coming years. The HPSR community must take advantage of this political development and harness its capacities to help the world’s countries succeed in this collective goal. In the coming years, we hope to see more colleagues from the HPSR community, especially emerging voices, scholars, and practitioners, to be part of this growing movement – to build health systems that do no harm to the planet and are adaptive to the challenges brought about by a rapidly changing climate. Join us!


Renzo R. Guinto is the Vice Chair of the Thematic Working Group (TWG) on Climate-Resilient and Sustainable Health Systems of Health Systems Global. He is the Chief Planetary Health Scientist of the Sunway Centre for Planetary Health in Malaysia and the Inaugural Director of the Planetary and Global Health Program of the St. Luke’s Medical Center College of Medicine in the Philippines. His Twitter handle is @RenzoGuinto

Revati Phalkey is the Chair of the TWG on Climate-Resilient and Sustainable Health Systems of Health Systems Global. She is the Head of the Climate Change and Health Unit of the UK Health Security Agency and Honorary Associate Professor in Global Health at Heidelberg University.

Upasona Ghosh is the Coordinator of the TWG on Climate-Resilient and Sustainable Health Systems of Health Systems Global. She is an Assistant Professor in environmental health and social and behavioural sciences at the Public Health Foundation of India.

Shibaji Bose is the Communications Lead of the TWG on Climate-Resilient and Sustainable Health Systems of Health Systems Global. A former journalist, he has co-curated photo voice exhibitions and directed films focusing on climate change and health systems, and his works have been featured by the Wellcome Trust and in Cannes Film Festival and HSG symposiums.

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