An evaluation of factors that influence the governance context of climate change adaptation and health

Addressing climate change and its associated health effects is a multi-dimensional and ongoing challenge. Climate change adaptation (CCA) is receiving increasing funding and policy attention, given, now, the inevitability of further climate change and its diverse impacts. However, with increased international funding for adaptation also comes challenges such as ensuring enabling policy environments for developing and implementing effective adaptation activities. Adaptation to climate change in the health sector requires collaborative decision-making across different sectors, levels of government, and organisations. Despite this, research, policy and advocacy communities have little understanding of how different organisations work together and combine their power to influence policy decisions and implementation, specifically in relation to health and climate change adaptation. An understanding of this broad governance 'map' is necessary given that the health impacts of climate change will arise primarily via sectors not directly linked to health, including water, agriculture and transport. The aim of my research was to assess the policy context and decision-making arrangements in relation to the development of policy related to CCA and health. The geographical focus of the study was Cambodia. To achieve this aim I used key stakeholder interviews to assess (i) the policy context for CCA and health in Cambodia, and (ii) the decision-making networks in relation to the development of CCA and health policy and activities. Results suggest that an enabling environment is beginning to emerge around health and CCA, given the cross-sectoral and -organisational partnerships, and the increasing attention on climate change at a high level politically. Many barriers persist, though, including the slow pace of the Cambodian government's completion of the Second National Communication, which outlines CCA priorities, as well as the competition that exists amongst different organisations for CCA funding. Suggestions to strengthen adaptation efforts relevant to health include (i) integration of health-related adaptation activities within development plans, poverty reduction strategies, and relevant sectoral policies, (ii) embedding of health professionals within relevant ministries, including climate change/environment, rural development, agriculture and water, and (iii) rapid scaling-up of capacity development of Cambodian nationals to increase basic and practical knowledge of approaches to respond to climate change and health issues. This research has presented a novel approach to evaluate the governance context of climate change adaptation and health in Cambodia. The findings have relevance beyond the context of Cambodia; the research is a step towards assisting advocacy and leverage efforts to strengthen global responses to climate change. There is great potential for CCA funding, policy and action to redress the current global health imbalance. If we can make advances to reduce the risks to health from climate change we will also be making substantial progress on reducing broader existing health burdens and their inequities