The United Kingdom of Great Britain and Northern Ireland

Index test

The case study has shown that the UK’s CHAIn score generally reflects the country’s performance in the field of climate change and health and that most of the relevant documents on the UK’s health adaptation to climate change had been identified as part of the analysis for the CHAIn. The documents that were considered in the UK’s assessment for the CHAIn include: a) the most recent NC to the UNFCCC in the respective research period (NC 7 from 2017), the Health Protection Agency’s report “Health Effects of Climate Change in the UK 2012,” and the British government’s “National Adaptation Programme” from 2013.

The expert interviews revealed that, after the end of the assessment period for the UK’s CHAIn score, a new National Adaptation Programme had been published. Although the new document contains additional information on the UK’s progress in the field of climate change and health, it cannot be added to the CHAIn database since a time freeze was in place once the assessment started in order to ensure that the results are comparable. Moreover, the interviews showed that additional key documents for health adaptation to climate change in the UK are the Climate Change Act of 2008, the UK Climate Projections (UKCP), and the Climate Change Risk Assessments.1 The UKCP constitutes a climate analysis tool and is produced by the UK’s Met Office, the meteorological agency of the UK government. It was first published in 2009 and the newest document stems from 2018. The Climate Change Risk Assessment gives an overview of all climate change related risks for the UK and was first published in 2012. It is updated every five years. In addition to the general documents on adaptation to climate change, some publications specifically for the health sector have been released in recent years. In addition to the Health Protection Agency’s documents on the health effects of climate change, which were already included in the CHAIn assessment, the National Heatwave Plan from 2004 integrated the UK’s adaptation policies against heatwaves. Although the information there is relevant for the country’s health adaptation to climate change, the health-related aspects were later included in the national adaptation program and the health effects of climate change document and are thus captured by the CHAIn assessment.

Consequently, the vast majority of health adaptation initiatives were identified by the CHAIn assessment. The index score is thus a true representation of the overall national-level health adaptation actions to climate change that the UK reported. Moreover, the handbook-guided expert interviews and the review of relevant peer-reviewed journal articles have shown that the majority of policies and programs that the British government reported on in their official documents are actually rooted on the ground and involve concrete actions. Therefore, it can be assumed that the index score constitutes a representation of the actual level of health adaptation to climate change in the UK.

Governance

The UK’s response to climate change related health risks differs greatly from that of the rest of the world. To better understand what the UK does against such risks and how it works, this section starts with an international comparison of the UK’s health adaptation portfolio and continues with an overview of the institutional framework and the key actors in the field, before it moves to the discussion of the UK’s main policies and changes over time.

International comparison

With an overall score of 109, the UK ranks at number 1 on the CHAIn, followed by the RoK (CHAIn score of 103.25), Jordan (71.25), Canada (70.5), and Cyprus (61). Although the RoK has implemented even more adaptation-level actions (adaptation score of 88), the UK is among the countries with the highest adaptation score (60). Moreover, it has the second highest groundwork score of all countries (42), with only Jordan having a higher groundwork score (56.25). Other countries that rank high on the CHAIn, such as the RoK, Canada, or Cyprus, have a significantly lower groundwork score and are mainly at the top due to their high adaptation score. The UK, however, has a solid balance between groundwork and adaptation, and it also has the highest possible recognition score (7).

Health adaptation portfolio

In its official national documents, the UK recognizes all health risks that academia currently associates with climate change, which shows that the British government is aware of a wide range of risks. As Figure 8.1 underlines, in terms of its groundwork-level measures, the UK has a strong tendency towards general measures (24) and initiatives that address health risks associated with floods and storms (17). Groundwork-level initiatives against

Groundwork-level initiatives in the UK

Figure 8.1 Groundwork-level initiatives in the UK

heat-related health risks rank at place 3, with 12 measures in total, whereas cold-related health risks are only addressed in five groundwork-level initiatives. With ten groundwork-level measures against climate change related health risks in relation with air pollution and nine risks related to UV radiation, the UK does much more in this field than many other states. The UK’s groundwork-level initiatives on secondary health risks all range between ten and eleven measures per risk. Groundwork-level measures that address tertiary risks, such as mental health risks (2 groundwork initiatives), health risks related to migration (no measures), or health risks related to conflicts (no measures), are almost nonexistent.

Looking at Figure 8.2, it becomes clear that by far the most adaptation- level initiatives address climate change and health in general and are not risk-specific. The official documents did not mention any heat-related adaptation actions or implemented adaptation measures that address allergies or risks associated with climate change related migration or conflicts. The categories droughts and fires, UV radiation, infectious diseases, and mental health accounted for one adaptation initiative each, whereas two health adaptation initiatives on cold-related health risks were reported on. Floods and storms, the same as risks related to air pollution, water and sanitation, as well as food and agriculture, accounted for three adaptation initiatives each. Compared with groundwork initiatives, the discrepancy between general measures and risk-specific measures is even higher and many risk-specific groundwork-level initiatives, such as those that focus on heat-related risks or allergies, are not followed up with implemented adaptation initiatives. This shows that, despite some progress in terms of implemented adaptation actions, the majority of the reported health adaptation work of the UK is still on the groundwork-level and most of its implemented adaptation actions do not address concrete risks.

The UK and Northern Ireland 135

Adaptation-level initiatives in the UK

Figure 8.2 Adaptation-level initiatives in the UK

At the same time, the vast majority of adaptation measures that the UK reported on are recommendations and do not indicate that action has been taken already. Moreover, a great number of strategies and plans, which include concrete steps on what exactly should be done and until when, have been developed over the years (26 reported measures). At the same time, 19 research and development projects were mentioned in the official documents, which shows that the UK’s health adaptation work has a strong research background. Two communication tools complete the groundwork portfolio of the UK, which results in 122 total groundwork-level initiatives. Compared with the 26 adaptation-level initiatives, the number of

Adaptation types in the UK groundwork-level initiatives clearly dominates the UK’s health adaptation portfolio

Figure 8.3 Adaptation types in the UK groundwork-level initiatives clearly dominates the UK’s health adaptation portfolio. However, it needs to be taken into account that adaptation-level actions are usually more complex and take more efforts to implement than groundwork-level actions, which is why they are also weighted differently on the CHAln. The adaptation-level actions themselves consist mostly of capacity building measures (14), monitoring and warning systems (6), and education and awareness programs (4). One measure in the category practice and behavior and one technology instrument were reported, while no infrastructure or financing measures were mentioned in the official documents.

Institutional framework and key actors

Whilst the UK undertook some work on health adaptation to climate change already in the early 2000s, especially with regards to protection from heatwaves, the government’s efforts to respond to climate change related health risks really took off with the adoption of the Climate Change Act in 2008 (Oxford University, personal communication, 27 November 2018). It led to the establishment of a great number of new institutions in the field of climate change adaptation, including the Committee on Climate Change and the Adaptation Sub-Committee of the Committee on Climate Change, and the expansion of Public Health England’s Climate Change group and the health adaptation work of other governmental agencies (Oxford University, personal communication, 27 November 2018; London School of Hygiene and Tropical Medicine (LSHTM), personal communication, 25 November 2018). The Adaptation Sub-Committee monitors the government’s progress on adaptation to climate change, including the National Adaptation Programme, and it requires the respective governmental branches to report to the committee on how they take action (LSHTM, personal communication, 25 November 2018).

All of the government’s adaptation initiatives to climate change are coordinated and integrated by the Department for Environment, Food &. Rural Affairs (DEFRA) (DEFRA, personal communication, 28 November 2018). The respective departments, such as the Department of Health and Social Care (DHSC), have the responsibility to develop their own sector-specific adaptation plans and programs and DEFRA gathers the information and integrates them in joint documents to provide a better overview and enable cooperation among the respective departments (DEFRA, personal communication, 28 November 2018). Moreover, DEFRA works closely with governmental agencies and other partners, such as Public Health England (PHE) and the Sustainable Development units in the UK (DEFRA, personal communication, 28 November 2018). One of DEFRA’s major responsibilities is to produce the National Adaptation Program, which is updated every five years and was first published in 2013 (DEFRA, personal communication, 28 November 2018). It follows the release of the climate change risk assessments by the Adaptation Sub-Committee (DEFRA, personal communication, 28 November 2018). The Climate Change Risk Assessment summarizes all climate change related risks for the UK and thus helps to identify where adaptation is necessary (Oxford University, personal communication, 27 November 2018). It contains information on a great variety of risks, including health risks (Oxford University, personal communication, 27 November 2018). The Climate Change Risk Assessment is built on the results of the UK Climate Projections (UKCP), which are published by the Met Office, the UK’s national weather service, and were first released in 2009 (Oxford University, personal communication, 27 November 2018). The most recent projection stems from 2018.

Whilst the overall adaptation process is coordinated by DEFRA, the Department of Health has the responsibility to develop health-related adaptation policies and programs (Oxford University, personal communication, 27 November 2018). It needs to be recognized, however, that the department’s capacity to deal with the impact of climate change on health is comparatively low. According to experts, only one part-time position is dedicated to the subject programs (Oxford University, personal communication, 27 November 2018). Therefore, governmental agencies, such as Public Health England or the Sustainable Development Unit advise and support the ministry’s work on a frequent basis and have a strong influence on the government’s policies in the field (Oxford University, personal communication, 27 November 2018).

Public Health England is an Executive Agency to the Health Department and was established to protect and improve the health and well-being of the British people and to reduce health inequalities among them (Oxford University, personal communication, 27 November 2018). Its activities include advocacy work, networking, research, and delivering public health services (Oxford University, personal communication, 27 November 2018). Out of the 5,500 employees of Public Health England, around 900 work under the Health Protection Directorate (Oxford University, personal communication, 27 November 2018). Around 350 serve under the Centre for Radiation, Chemical and Environmental Hazards, which is again divided into the Chemicals &. Environmental Effects Department and the Environmental Hazards Department. The Climate Change Group (six people) is based under the Chemicals and Environmental Effects Department and provides scientific research, advice and guidance to the UK government, local authorities, and other stakeholders (Oxford University, personal communication, 27 November 2018). It participates in international and national research projects and has strong links with universities and other research organizations (Oxford University, personal communication, 27 November 2018). Within Public Health England, the Climate Change Group cooperates with the Extreme Events & Health Protection Group, which is based under the Environmental Hazards Department. Public Health England’s goals and objectives in the field of climate change and health often originate in the

138 The national perspective

Climate Change Group and are subsequently passed on to higher levels within the organization before they arrive at the Health Department, which again coordinates with DEFRA before the proposal goes to the ministers (Oxford University, personal communication, 27 November 2018).

Overall, according to experts in the ministries, within the last eight years, the UK government has had lots of changes in the field of climate change, and an increasing number of officials is available to deliver policies and projects (DEFRA, personal communication, 28 November 2018). At the same time, however, many departments do not have the resources to do more than they are currently doing, although there is a desire to increase their adaptation efforts (DEFRA, personal communication, 28 November 2018).

Changes over time

As Figure 8.4 shows, it took until the release of the report “Health Effects of Climate Change in the UK 2012” in 2012 for the UK’s health adaptation measures to really take off and, even then, the majority of reported mea- sures were groundwork initiatives (Vardoulakis and Heaviside 2012). The largest increase in reported measures occurred in 2013 with the release of the National Adaptation Programme, in which the UK reached almost a perfect recognition score (6.5 out of 7 points), a comparatively high groundwork score (16.5 points), and the highest adaptation score in the country’s history (58). The number of groundwork-level initiatives peaked in 2012 with a score of 25, rapidly decreased with the sixth NC to the UNFCCC and rose to 16.5 points again with the National Adaptation

Time comparison of health adaptation measures in the UK

Figure 8.4 Time comparison of health adaptation measures in the UK

Programme from 2013. The high groundwork score in 2012 is mostly due to an exceptionally high number of recommendations (76 counted recommendations), whereas the National Adaptation Programme in 2013 does not include any recommendations on climate change and health but a large number of strategies and plans (25 counted strategies and plans).

Interestingly, the reporting of health adaptation initiatives in the NCs to the UNFCCC is constantly at a very low level. Only the NC7 from 2017 mentions more than one adaptation initiative and, compared with the initiatives mentioned in the other national documents, the reported measures in the NCs are extremely low.

Drivers and barriers

Climate change and health in the UK - risk assessment

According to the ND-GAIN index, the UK is among the least vulnerable countries to climate change in the world (ND-GAIN 2019b). Due to its comparatively low vulnerability score and its high readiness score, the UK represents the eight least vulnerable country on the ND-GAIN index (ND-GAIN 2019a). Health specific indicators on the ND-GAIN index demonstrate that challenges still exist, yet the high readiness of the country shows that it is generally better prepared to deal with risks stemming from climate change than other countries (see Table 8.1).

The health specific ND-GAIN data shows that the UK does not face any health risks due to a change of cereal yields, and only a very small fragment of the population will likely have to deal with deadly climate change related diseases (ND-GAIN Score of 0.030 compared with 0.303 for Sri Lanka or 0.333 for Sierra Leone). At the same time, the UK faces a high projected change in vector-borne diseases (0.658), a high flood hazard (0.735), and a relatively high impact of sea level rise (0.324).2 As a consequence, it is clear that the UK has to adapt to climate change related health risks with a focus on preventing the spread of infectious diseases, preparing against health risks associated with extreme weather events, especially floods, and reacting

Table 8.1 ND-GAIN scores for climate change related health risks in the UK

Risk

ND'QAIN score

Projected change of cereal yields

0

Projected change of deaths from climate change induced diseases

0.030

Projected change in vector-borne diseases

0.658

Projected change of warm periods

0.114

Projected change of flood hazard

0.735

Projected change of sea level rise impacts

0.324

to the consequences of sea level rise. Other climate change related health risks, such as heat-related risks (0.114 ND-GAIN score in the category “projected change of warm periods”), should not be neglected. However, according to ND-GAIN, they play a less prominent role than other risks.

The analysis of data from the World Bank Climate Change Knowledge Portal leads to similar findings. Depending on the emission scenarios, the probability of an annual heatwave between 2040 and 2059 is 0.04 (RCP 4.5) or 0.06 (RCP 8.5). Although the probability rises the further the projection goes into the future, overall, the probability of a heatwave is in the UK still much lower than in other countries. The probability of a cold wave is projected to remain at —0.01 between 2040 and 2059 and then slightly decrease to —0.02 (RCP 4.5). Under a high emission scenario, the probability of a cold wave is to increase even faster, to —0.02 between 2040 and 2059, and then remain steady (RCP 8.5). This shows that, based on the projections, the UK will likely face slightly fewer cold-related health risks, such as death caused by hypothermia etc. The annual severe drought likelihood is not projected to largely increase in a medium-low emission scenario (RCP 4.5). Under a high emission scenario, the projected annual severe drought likelihood will increase to 0.09 by 2040-2058 and 0.10 by 2060-2079 (RCP 8.5), which is still a rather moderate increase compared with other countries.

Based on the results of the ND-GAIN index as well as the World Bank projections, it can be summarized that the major climate change related health risks for the UK are related to floods and storms, sea-level rise, and infectious diseases. Heat-related diseases may become an issue as well, but other countries will be significantly more affected. Information on secondary and tertiary climate change related health risks is rather scarce, which is why no qualified projections on allergies, mental health risks, migration, and conflicts can be made. Based on current research, it can be expected that especially mental health risks and allergies will become increasingly relevant.

Risks assessment by experts from the UK

According to top experts on climate change and health in the UK, the major climate change related health risks for the country are related to extreme weather events and extreme temperature, especially floods and heatwaves (LSHTM, personal communication, 25 November 2018; Leeds University, personal communication, 29 January 2019). This goes along with the findings of the UK Climate Change Risk Assessment 2017 Synthesis Report, which identifies an urgent need to act against floods and coastal change, health risks due to high temperatures, and, to a lesser extent, risks related to water and sanitation, food and agriculture, and new and emerging diseases (Committee on Climate Change, (CCC) 2016, 2). Moreover, risks related to food security and infectious diseases may become more serious as climate change will gain speed (LSHTM, personal communication, 25 November 2018). At the same time, an expert from Leeds University noted that the number and complexity of climate change related health risks in the UK is much larger (Leeds University, personal communication, 29 January 2019). Air quality related risks or those related to cardio-vascular and respiratory diseases will, for instance, become more prevalent in a changing climate and many risks have not yet been identified (Leeds University, personal communication, 29 January 2019).

Risk perception and the political agenda

For the last few years, BREXIT discussions have dominated the political agenda, making it difficult for other topics, such as climate change, to receive enough political attention (DEFRA, personal communication, 16 January 2019; Oxford University, personal communication, 27 November

2018) . In the earlier 2000s, climate change was prominent on the agenda (DEFRA, personal communication, 16 January 2019). This was at least partly due to the massive heatwaves in the UK in 1996, 2003, and 2006, which were associated with climate change and led to heightened societal and political attention (DEFRA, personal communication, 28 November 2018; DEFRA, personal communication, 16 January 2019). Policies and institutions to combat climate change and its effects really developed after the 2003 heatwave, which many experts described as a “wake up call in all Europe” (Leeds University, personal communication, 29 January 2019). The UK, for instance, started to develop its national heatwave plan as a reaction to the extreme temperatures and, overall, climate change was high on the agenda (Leeds University, personal communication, 29 January 2019). The awareness and actions culminated in the Climate Change Act from 2008, which led to the establishment of the British Framework on Climate Change, the creation of various institutions that work on the different aspects of climate change and health, and overall widespread recognition that both adaptation and mitigation are needed in the UK to respond to climate change related risks (DEFRA, personal communication, 28 November 2018).

After 2008, climate change gradually lost attention during austerity and became more contested (DEFRA, personal communication, 16 January

2019) . Nevertheless, unlike in other countries, there is not much climate change denial and a cross-party consensus exists on the fact that climate action is necessary (DEFRA, personal communication, 16 January 2019). One official from DEFRA stated: “Climate skepticism around science has been put to bed” (DEFRA, personal communication, 16 January 2019). However, disagreements both in the media and politics persist regarding which specific measures should be taken (DEFRA, personal communication, 16 January 2019).

Climate change and health is still, at least from time to time, on the government’s agenda, but the focus often lies on a small number of health risks rather than the complex relationship between climate change and health

(Leeds University, personal communication, 29 January 2019). Much of the debate focuses on heat-related health risks, while more diffuse risks, such as those related to air quality or cardio-vascular and respiratory diseases, are less discussed, although they will become more prevalent as climate change progresses (Leeds University, personal communication, 29 January 2019). Governmental experts confirmed that the major climate change related health risks that the government is concerned about are related to severe weather events, such as flooding, and extreme temperatures (DEFRA, personal communication, 28 November 2018). Especially the heatwaves have led to more attention for the health effects of climate change and, therefore, the prompted government to foster research on the topic to reduce uncertainty and build adaptive capacity (DEFRA, personal communication, 28 November 2018).

In 2018 and the beginning of 2019, climate change has received more awareness again, as extreme weather events, especially floods, hit the UK and pushed climate change more to the agenda (DEFRA, personal communication, 16 January 2019). During the 2018 heatwave, a new scientific report on heat effects was published and public awareness rose again. However, after some time, other topics pushed the topic away from the agenda (LSHTM, personal communication, 25 November 2018). Nonetheless, compared with around ten years ago, adaptation has gained much more relevance and attention, and institutions such as the Adaptation Sub-Committee have contributed to raising awareness for adaptation, engaging with civil society, mainstreaming adaptation across different policy areas, and monitoring the government’s progress in the field (LSHTM, personal communication, 25 November 2018). Recently, mitigation and adaptation have become more separated in public debate, but, unlike in other countries, climate change adaptation does not have a negative image in the UK (LSHTM, personal communication, 25 November 2018).

Dealing with complex decisions under uncertainty

The nexus between climate change and health is very complex and still some uncertainty exists in terms of the concrete climate change related health risks that are and will become relevant in the UK, as well as the scale and intensity of the risks (DEFRA, personal communication, 16 January 2019). Therefore, universities and research institutes play an important role for the government’s health adaptation efforts. According to a governmental official, especially senior academics and larger research centers have a lot of influence on climate change adaptation in the UK (DEFRA, personal communication, 16 January 2019). At the same time, some interviewed scholars claimed that more interdisciplinary research was necessary to develop an even better understanding of the issue (Leeds University, personal communication, 29 January 2019).

It is worth noting that the UK’s level of research on the topic is far higher than that of other countries and, after the heatwaves in 1996 and 2003, the government has financed many research projects on the impacts of climate change, including the health sector (DEFRA, personal communication, 28 November 2018). Academia plays an especially important role for governmental agencies, such as the Health Protection Agency (LSHTM, personal communication, 25 November 2018; Oxford University, personal communication, 27 November 2018). Consequently, the UK is much better prepared to deal with the uncertainty connected to climate change and can make more informed decisions, which can at least partially explain the UK’s high ranking on the CHAIn. As experts from the LSHTM stated, for policymakers it is important to have a strong evidence base, and in the UK research findings now show the impact of climate change on people’s health more clearly than ever (LSHTM, personal communication, 25 November 2018). Not only is this important for decision makers to identify current priorities, but it also helps them to measure a “return of investment” (LSHTM, personal communication, 25 November 2018). Especially the Climate Change Act from 2008 was a starting point for capacity building both in the public sector and with regards to funding research projects in the field (Oxford University, personal communication, 27 November 2018). Moreover, research institutes in the UK benefited from EU funding on climate change and health (LSHTM, personal communication, 25 November 2018).

Governmental institutions in the field of climate change have undergone many changes in the past eight years and more officials are now working on climate change related topics than before (DEFRA, personal communication, 28 November 2018). The link between academia and politics has improved over time and more research councils have been established to provide expertise on the specific impact of climate change in the UK (DEFRA, personal communication, 28 November 2018). Additionally, an increasing number of interdisciplinary and cross-sectoral projects has been conducted (DEFRA, personal communication, 28 November 2018).

The social and cultural dimension

In the UK, the public is aware of and well-informed about climate change in general, but less so about the various health effects of climate change (Leeds University, personal communication, 29 January 2019). Especially when it comes to new emerging diseases as a consequence of climate change, the public understanding is rather limited (Leeds University, personal communication, 29 January 2019). Although, according to experts, health is not the first thing that comes to people’s minds when they think about climate change, numerous civil society organizations have gathered support for climate action and raised awareness for the health effects of climate change in the UK (LSHTM, personal communication, 25 November 2018). Their influence largely varies over time, but there are Non-Governmental

Organizations (NGOs) that put pressure on the government by organizing demonstrations and raising awareness through media campaigns (DEFRA, personal communication, 28 November 2018; Leeds University, personal communication, 29 January 2019). One example is the Extinction Rebellion, which protests to raise awareness for climate change by blocking bridges and claiming that politicians are killing humanity with their inaction (BBC 2019). Friends of the Earth, the Global Action Plan, Client Earth, and others also strive to raise awareness and push for stronger governmental climate action (DEFRA, personal communication, 28 November 2018; Oxford University, personal communication, 27 November 2018). Moreover, specific health- related NGOs and advocacy groups exist. The UK Health Alliance on Climate Change advocates for more health specific mitigation and adaptation measures as well as an even stronger research basis (HACC 2019) The Lancet Countdown on Climate Health and Climate Change unites researchers, representatives of international organizations, and activists, and publishes annual reports on the effects of climate change on health across the globe (LSHTM, personal communication, 25 November 2018).

The influence of civil society organizations peaked with the passing of the Climate Change Act in 2008 and, since then, it rises and declines in relation to other developments, such as major climate change negotiations and agreements or extreme weather events (DEFRA, personal communication, 16 January 2019). Environmental NGOs mostly receive media attention when international climate change related events happen or specific projects, such as the expansion of airports, are discussed (DEFRA, personal communication, 16 January 2019). Now with BREXIT dominating the discussions, more and more NGOs lobby for making the exit as green as possible and see it as an opportunity to redirect public money towards protecting the environment (DEFRA, personal communication, 16 January 2019).

The economic dimension

Although the UK is economically well situated and, compared with other countries, has enough capacity to invest in long-term challenges such as climate change, general economic trends, such as the European economic crisis that began to unfold in 2008 and the national austerity policy, had an effect on health adaptation to climate change in the UK (DEFRA, personal communication, 16 January 2019; Leeds University, personal communication, 25 January 2019). During austerity, other topics dominated the agenda and climate change received less attention (DEFRA, personal communication, 16 January 2019). Moreover, due to cutbacks as part of the austerity policies, the health care sector has received less funding in recent years, although with regards to the UK’s demographic development, even more investments are necessary (Leeds University, personal communication, 25 January 2019). According to an expert on social environmental policies, this has led to a social dilemma where the willingness to pay for health care is not there and the UK’s health system is under a lot of pressure (Leeds University, personal communication, 25 January 2019). Due to these immediate and mediate challenges, climate change is not on the forefront of the agenda of the health sector (Leeds University, personal communication, 25 January 2019).

At the same time, when the adaptation framework was institutionalized in the early 2000s, local governments were given major responsibilities and funding to work on adaptation, especially with regards to flooding and health risks (Leeds University, personal communication, 25 January 2019). During austerity, however, the government abolished the old adaptation system and the local government level lost a large part of its funding (Leeds University, personal communication, 25 January 2019). Since other public services were more pressing, the local entities had to cut their efforts on climate change and, as a consequence, policy-dismantling took place (Leeds University, personal communication, 25 January 2019). This was less an issue for mitigation since it had been enshrined in law, but adaptation really suffered from the austerity policies (Leeds University, personal communication, 25 January 2019). Still, many mechanisms and institutions, such as he Adaptation Sub-Committee are still in place and work effectively (Leeds University, personal communication, 25 January 2019).

Both in politics and the general public, the economy is often at the top of the agenda, whereas the environment is more at the bottom (DEFRA, personal communication, 16 January 2019). People often care more about specific risks, such as those related to floods or heat (DEFRA, personal communication, 16 January 2019). If asked about these risks, environmental issues often jump right to the top of their priorities (DEFRA, personal communication, 16 January 2019). Moreover, an increasing number of people makes the connection between climate change and health, which often leads to more awareness for climate change in general (DEFRA, personal communication, 16 January 2019). On the ministerial level, however, the link between climate change and health is less prominently discussed (DEFRA, personal communication, 16 January 2019).

The international dimension

The majority of interviewed experts has claimed that the direct influence of international organizations, such as the WHO, is rather limited in the UK since these organizations are more active in developing countries (LSHTM, personal communication, 25 November 2018). Although the WHO’s office in Bonn has a focus on climate change and health and provides technical support to European countries, it does not get much involved in developing policies with and for European countries since it focuses more on technical details (LSHTM, personal communication, 25 November 2018). In developing countries, on the other hand, the WHO, other international organizations, or even single countries, have a strong influence on health adaptation policies (LSHTM, personal communication, 25 November 2018). Germany, for instance, has funded several National Adaptation Plans for developing countries (LSHTM, personal communication, 25 November

2018) . This observation goes along with the finding from the longitudinal assessment of the NCs to the UNFCCC, which shows that the UK does not report as extensively on their health adaptation policies in their NCs than in their national-level documents, such as the National Adaptation Programme.

Despite the comparatively low direct influence, international organizations definitely have a strong indirect influence on health adaptation in the UK. International events, such as Conferences of the Parties to the UNFCCC (COPs) or G7 and G20 meetings, can bring the topic to the agenda and put pressure on governments to act against climate change (DEFRA, personal communication, 16 January 2019; Oxford University, personal communica- tion, 27 November 2018). The UK often plays an important role in shaping international climate change agreements and increasing global ambition, as was the case especially with the Paris Agreement in 2015 (DEFRA, personal communication, 16 January 2019). The UK tends to strive for international reputation at international climate change conferences and is interested in coming across as a very engaged climate leader (DEFRA, personal communication, 16 January 2019). Overall, the UN and its various institutions have strong legitimacy in the UK, and especially the WHO is frequently mentioned in governmental decisions (DEFRA, personal communication, 16 January 2019). The WHO’s benchmarks and reports are usually considered by British policymakers, which leads to what one of the interviewed experts called “soft power” through their legitimacy and through shaping the discourse (DEFRA, personal communication, 16 January 2019). Moreover, the WHO often sets concrete standards that are picked up by decision makers (DEFRA, personal communication, 16 January 2019). As a consequence, the WHO is one of the most respected and talked about UN organizations in the UK (DEFRA, personal communication, 16 January

2019) . The climate change debate is slightly more contested, which is why, from the perspective of a DEFRA official, the UNFCCC is less influential than the WHO (DEFRA, personal communication, 16 January 2019). UN Environment is even less acknowledged than the UNFCCC since many policymakers prefer to set their own environmental standards rather than adhering to international ones (DEFRA, personal communication, 16 January 2019). The IPCC’s publications, on the other hand, are broadly received, and especially the recent special report “Global Warming of 1.5 °C” has helped to set climate change on the agenda and put pressure on policymakers in the UK to increase their adaptation and mitigation efforts (DEFRA, personal communication, 28 November 2018).

The EU also plays an important role for the UK’s adaptation policies, as it sets standards and requires reporting in many areas (LSHTM, personal communication, 25 November 2018). The EU Climate Adapt program and the EU’s questionnaire on climate change adaptation are of importance for the UK’s adaptation policies since they require them to summarize their efforts and report them to the EU (Oxford University, personal communication, 27 November 2018). Moreover, the EU’s funding for research projects in the UK contributed to the development of a strong research basis for the government’s decisions on the topic (Oxford University, personal communication, 27 November 2018).

Furthermore, a number of experts stated that cooperation between the UK and other states is rather limited and mostly occurs when governmental delegations visit the UK (DEFRA, personal communication, 16 January 2019; Oxford University, personal communication, 27 November 2018). Nevertheless, in some cases, governmental agencies, such as Public Health England, develop projects with foreign partners, as was the case for a project in Cyprus (Oxford University, personal communication, 27 November 2018). A few years ago, Public Health England conducted a project in Cyprus where they developed a heatwave preparedness plan for this Mediterranean country and launched first research projects on climate change and health (Oxford University, personal communication, 27 November

2018) . Clearly, this form of cooperation is more beneficial to the partner country, in this case Cyprus, but it shows that policy diffusion from the UK to other countries takes place. Moreover, the high rank of Cyprus may at least partially be explained through the support they received.

Overall, international organizations are definitely an important player in the UK since they work closely with academia, shape the discourse, raise awareness, and set standards (DEFRA, personal communication, 16 January

2019) . Unlike in developing countries, however, there is usually no concrete support for project development and implementation within the UK since the UK has been a leader on climate change and has a lot of own research capacity (DEFRA, personal communication, 16 January 2019).

Summary

The UK’s strong performance on the CHAIn can be traced back to the lessons learned from extreme weather events in the early 2000s, especially the heatwave from 2003. Although the UK was and is not significantly more affected by climate change than other countries, the topic was high on the political agenda between 2003 and 2007 and civil society’s pressure on the government to act against climate change and its consequences significantly rose. The awareness for climate change culminated in the adoption of the Climate Change Act in 2008, which led to the establishment of stronger institutions and higher capacities in the adaptation sector. Especially public agencies, such as Public Health England, established working groups on climate change and health. After the economic crisis in 2008 and the resulting austerity policy, climate change received much less attention and since then the topic mostly gets on the agenda when important international conferences happen and groundbreaking agreements, such as the Paris Agreement (2015), are adopted. Moreover, funding for adaptation has been cut, especially on the local level, and additional pres- sure on the health system has led to a change of priorities and less atten- tion for climate change related health risks. Since the UK’s vote to leave the EU on 23 June 2016, the political agenda has been dominated by Brexit discussions and climate change has received less awareness. Civil society organizations used to be rather strong in the early 2000s and now rise every now and then, as the example of the Extinction Rebellion shows. Their presence often correlates with international developments or climate change related events within the country, such as discussions on expansions of airport runways.

Nevertheless, the institutions that developed after the adoption of the Climate Change Act as well as the strong research basis in the UK, with the world’s best universities and research institutes, help the country to reduce some of the uncertainty and complexity that the nexus between climate change and health involves. As a consequence, much more is known about the specific climate change related health risks in the UK than in other countries, and it is easier for decision makers to justify their actions since they can more easily than elsewhere show a return of investment. The UK’s reaction to the heatwave in 2003 and other events differed from that of other European countries, especially since it led to a new wave of institu- tionalization of climate action, from which the UK’s health adaptation work still benefits. This shows that the perception and policy learning from extreme weather events really differs from country to country and it is not just the exposure or vulnerability to such events, but it is key to have a political environment that enables policy learning and the necessary knowledge and expertise to develop solutions.

Notes

  • 1 All of these documents were identified as part of the CHAIn analysis.
  • 2 The Projected change of cereal yields describes the “projected impact of climate change on the actual yields of rice, wheat and maize. Projected change is the percent decrease of the cereal yields from the baseline projection (1980-2009) to a future projection (2040-2069) using RCP 4.5 emission scenario” (ND-GAIN 2019b). The projected change of flood hazard implies “Projected impact of the climate change on flood. The flood hazard is measured by the monthly maximum precipitation in 5 consecutive days. The projected change is the percent increase of the flood hazard from the baseline projection (1960-1990) to the future projection (2040-2070), using RCP 4.5 emission scenario” (ND-GAIN 2019b).

References

BBC. 2019. “Extinction Rebellion protests: what happened?” BBC Online, 25 April.

https://www.bbc.co.uk/news/uk-england-48051776.

CCC. 2016. UK Climate Change Risk Assessment 2017. London: Committee on Climate Change.

HACC. 2019. “About.” Accessed 25 May 2019. http://www.ukhealthalliance.Org/a bout/.

ND-GAIN. 2019a. “The ND-GAIN Matrix.” Accessed 23 May 2019. https://ga in-new.crc .nd.edu/matrix.

ND-GAIN. 2019b. “United Kingdom.” Accessed 23 May 2019. https://gain.nd.edu/ our-work/country-index/.

Vardoulakis, Sotiris, and Clare Heaviside. 2012. Health Effects of Climate Change in the UK 2012. London: Health Protection Agency.

 
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