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By 2030, the direct adaptation costs to the health sector due to climate change are expected to cost between USD$2 to USD$4 billion a year. People in many low- and middle-income countries already suffer from several health challenges, such as malnutrition and a high occurrence of infectious diseases, challenges that will be intensified by climate change and variability. Furthermore, these countries often have health systems with a limited capacity to adapt to and prepare for future climate scenarios. As a result, many of the poorest and most vulnerable countries are likely to bear the brunt of health impacts resulting from climate change and variability. The Intergovernmental Panel on Climate Change identified health as the sector with the greatest potential to reduce the impacts of climate change in many lower- and middle-income countries if adaptation measures are taken. In this paper, we use case studies from a project funded by the United States Agency for International Development (USAID) to examine how to design programmes to reduce climate risks in the health sector. The USAID project called the Adaptation, Thought Leadership, and Assessment (ATLAS) Project and it assisted public health institutions in lower- and middle-income countries. Four specific cases are presented: in Mozambique, supporting the National Institute of Health of to launch a climate and health research observatory; in Ethiopia, working with the Ministry of Health to include climate and weather information into malaria early warning systems; in sub-Saharan Africa, improving our understanding of the relationship between temperature and malaria to inform malaria elimination interventions; and working across all project countries (globally) to manage extreme heat to reduce impacts on human health and well-being. We analyze these four ATLAS Project case examples to identify lessons and opportunities for future decisions and investment in climate and health care system management and capacity building programmes. A user-driven participatory approach improves capacity-building efforts, especially around research for decision making.Identifying and attempting to overcome institutional barriers to work across the health and climate sectors is necessary early in the project design phase for cross-sectoral collaboration.Customized data analytics, such as climate forecasting and epidemiological surveillance, should be tailored to specific health risks.While work at the climate and health nexus is relatively new, there is an increasing number of programmes addressing this linkage. There is an opportunity to increase peer learning opportunities drawing on growing experience across countries. A user-driven participatory approach improves capacity-building efforts, especially around research for decision making. Identifying and attempting to overcome institutional barriers to work across the health and climate sectors is necessary early in the project design phase for cross-sectoral collaboration. Customized data analytics, such as climate forecasting and epidemiological surveillance, should be tailored to specific health risks. While work at the climate and health nexus is relatively new, there is an increasing number of programmes addressing this linkage. There is an opportunity to increase peer learning opportunities drawing on growing experience across countries.

Linking science and action to improve public health capacity for climate preparedness in lower- and middle-income countries