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Introduction: The global burden of maternal mortality remains high and inequitably distributed between countries. Antenatal care (ANC) was identified as critical component in achieving the Millennium Development Goal of improving maternal health. This scoping review aimed to summarize trends and critically explore research about ANC attendance for East African women conducted during the Millennium Development Goals initiative, with a specific focus on barriers to ANC access. Methods: Using a scoping review methodology, aggregator databases were searched for relevant articles. Articles were screened by independent reviewers using a priori inclusion criteria. Eligible articles were retained for data charting and analysis. Results: Following screening, 211 articles were analyzed. The number of relevant articles increased over time; utilized primarily quantitative methods; and involved authors with affiliations from various African countries. Many interrelated physical, social, and cultural factors influenced women's seeking, reaching, and receiving of quality ANC. The extent of studies identified suggest that ANC is a priority research area, yet key gaps in the literature exist. Limited qualitative research, and few articles examining ANC experiences of women from vulnerable groups (e.g. adolescents, women with a disability, and Indigenous women) were identified. Discussion: These context-specific findings are important considering the Sustainable Development Goals aim to nearly triple the maternal mortality reductions by 2030. In order to achieve this goal, interventions should focus on improving the quality of ANC care and patient–provider interactions. Furthermore, additional qualitative research examining vulnerable populations of women and exploring the inclusion of men in ANC would help inform interventions intended to improve ANC attendance in East Africa. [ABSTRACT FROM AUTHOR]

Access to safe drinking water is limited in many isolated areas, such as the Amazon where Indigenous peoples frequently reside. Identifying safe forms of drinking water accepted by the communities could have positive health benefits for Indigenous peoples. Many Amazon Indigenous peoples traditionally prepare and consume a fermented beverage called masato, which is frequently the only form of water consumption. Despite its widespread consumption and evidence of the health benefits of fermentation, masato remains poorly investigated. We partnered with a Shawi Indigenous community in the Peruvian Amazon to conduct participatory photography to research masato preparation, and to characterize key cultural features and to assess the presence of total and fecal coliform bacteria by using a membrane filter technique. Pictures show that masato preparation is a key part of cultural practices and that there are clear gender roles in the preparation process. We found that 100% of communal water sources (26/26) were contaminated with coliform bacteria; by contrast, fewer, 18% of masato samples (2/11), were positive for coliform. This exploratory study suggests that fermented beverages like masato merit further investigation as they represent an Indigenous method to improve water quality in Amazonian communities where water safety cannot be assured. [ABSTRACT FROM AUTHOR]

Comparative research on climate change adaptation policy struggles with robust conceptualization and measurement of adaptation policy. Using a policy mixes approach to address this challenge, we characterize adaptation policy based on a general model of how governments govern issues of societal interest. We argue that this approach allows for context-sensitive measurement of adaptation policy, while being both comparable and parsimonious. This approach is tested in a study of adaptation policies adopted by 125 local governments located in Canada, France, Germany, the Netherlands, and the UK. Using a systematic data collection protocol, a total of 3328 adaptation policies were identified from local council archives between the periods of January 2010 and May 2017. Results of this analysis suggest that there is structured variation emerging in how local governments govern climate change adaptation, which justifies calls for comparative adaptation research to use measurements that capture the totality of adaptation policies being adopted by governments rather than focusing on specific types of adaptation policy. We conclude with a discussion of key issues for further developing of this approach. [ABSTRACT FROM AUTHOR]

Research on climate change media coverage is growing. Few studies, however, have investigated how the media portrays climate change impacts on human health. This review, therefore, presents a quantitative spatiotemporal analysis of Canadian newspaper coverage of climate change impacts on health between 2005 and 2015. Using the ProQuest® and Eureka® databases, a multiphase systematic review strategy was employed to identify relevant English and French articles from two national and six regional high-circulation newspapers. Quantitative and qualitative data were extracted from 145 articles and analyzed to characterize the range, extent, and nature of climate-health newspaper coverage in Canada and to compare these characteristics by region and over time. Coverage varied by region, with the highest proportion of climate-health coverage in Northern Territories (Yukon, Northwest Territories, Nunavut). Over time, there was a decreasing publication frequency trend. Almost all articles described negative climate change impacts on health, with a predominant focus on infectious and chronic noninfectious diseases; however, less than half of the articles discussed climate change solutions. These trends suggest that current media coverage might not drive widespread public support for policies and actions needed to protect against projected climate-health risks. Consequently, as climate change continues to challenge human health, increasing media emphasis on climate change impacts on human health, as well as a shift toward enabling and empowering climate change communication, in which viable mitigation and adaptation options are emphasized, could help to spur action to reduce climate change health risks. [ABSTRACT FROM AUTHOR]

The concept of vulnerability is well established in the climate change literature, underpinning significant research effort. The ability of vulnerability research to capture the complexities of climate-society dynamics has been increasingly questioned, however. In this paper, we identify, characterize, and evaluate concerns over the use of vulnerability approaches in the climate change field based on a review of peer-reviewed articles published since 1990 (n = 587). Seven concerns are identified: neglect of social drivers, promotion of a static understanding of human-environment interactions, vagueness about the concept of vulnerability, neglect of cross-scale interactions, passive and negative framing, limited influence on decision-making, and limited collaboration across disciplines. Examining each concern against trends in the literature, we find some of these concerns weakly justified, but others pose valid challenges to vulnerability research. Efforts to revitalize vulnerability research are needed, with priority areas including developing the next generation of empirical studies, catalyzing collaboration across disciplines to leverage and build on the strengths of divergent intellectual traditions involved in vulnerability research, and linking research to the practical realities of decision-making. [ABSTRACT FROM AUTHOR]

Equity and efficiency should be considered when allocating resources for climate change adaptation. More than a decade after the Least Developed Countries Fund approved adaptation funds for 18 countries in 2003, it is possible to take the stock of investment data and to test empirically whether equity and efficiency have been factored into adaptation investment decision-making. To evaluate equity, one must determine if resources were distributed to areas of greatest need. Vulnerability assessments provide information on the global distribution of the need for adaptation. To evaluate efficiency, one must compare cost and benefit of an investment. Although it is difficult to assess ex-ante the cost and benefit of investment strategies, it is possible to measure efficient use of expenditures with readiness assessment, as a metric of capacity to deploy adaptation resources. We used vulnerability and readiness measures of the Notre Dame Global Adaptation Initiative (ND-GAIN) Country Index as proxies of equity and efficiency. This article quantitatively interrogates-through the lens of public fund allocation-the roles of vulnerability and readiness in shaping adaptation investment decisions. Our findings suggest that countries facing increasing impacts from climate change have received more adaptation investments from international sources than countries with less vulnerability. Further, international investments also preferentially flow to countries that are more ready to deploy adaptation resources. Since the most vulnerable countries are likely to be less ready for investment, our findings support the efforts to improve the investment potential of the most vulnerable countries by investing first to enhance their readiness, in order to unlock adaptation solutions. [ABSTRACT FROM AUTHOR]

Adaptation tracking seeks to characterize, monitor, and compare general trends in climate change adaptation over time and across nations. Recognized as essential for evaluating adaptation progress, there have been few attempts to develop systematic approaches for tracking adaptation. This is reflected in polarized opinions, contradictory findings, and lack of understanding on the state of adaptation globally. In this paper, we outline key methodological considerations necessary for adaptation tracking research to produce systematic, rigorous, comparable, and usable insights that can capture the current state of adaptation globally, provide the basis for characterizing and evaluating adaptations taking place, facilitate examination of what conditions explain differences in adaptation action across jurisdictions, and can underpin the monitoring of change in adaptation over time. Specifically, we argue that approaches to adaptation tracking need to (i) utilize a consistent and operational conceptualization of adaptation, (ii) focus on comparable units of analysis, (iii) use and develop comprehensive datasets on adaptation action, and (iv) be coherent with our understanding of what constitutes real adaptation. Collectively, these form the 4Cs of adaptation tracking (consistency, comparability, comprehensiveness, and coherency). [ABSTRACT FROM AUTHOR]

Vulnerability to the health impacts of climate change will be shaped by the existing burden of ill- health and is expected to be highest in poor and socio-economically marginalized populations. Sub-Saharan Africa, in particular, is considered a highly vulnerable region. This paper analyses the vulnerability and adaptive capacity of rural Bakiga communities in southwestern Uganda to climate-sensitive health risks. The objectives were threefold: i) identify key climate-sensitive, community-identified health priorities; ii) describe and characterize determinants of sensitivity to these health priorities at the individual, community and regional levels; and iii) assess the adaptive capacity of Bakiga. Data collection employed a combination of individual and key informant interviews, biographies, future storylines, and Photovoice. Three key health risks were identified by the study communities (malaria, food insecurity, and gastrointestinal illnesses) - all affected by local climatic and environmental conditions, livelihoods, land use changes, and socio-economic conditions. Adaptation within these communities is dependent on their capacity to reduce sensitivities to identified health challenges among the potential of increasing exposures. Crop diversification, reducing deforestation, expanding of livestock rearing, transfer of traditional knowledge, and access to affordable health services are among potential strategies identified. We demonstrate significant existing vulnerabilities to present day climate-related health risks and highlight the importance of non-climatic processes and local conditions in creating sensitivity to health risks. Our place-based understanding is useful to inform interventions or policies aimed to reduce exposure and sensitivity and support adaptive capacity as the conditions these communities face are consistent with many other sub-Saharan African countries. [ABSTRACT FROM AUTHOR]

Recent controversy has led to calls for increased standardization and transparency in the methods used to synthesize climate change research. Though these debates have focused largely on the biophysical dimensions of climate change, human dimensions research is equally in need of improved methodological approaches for research synthesis. Systematic review approaches, and more recently realist review methods, have been used within the health sciences for decades to guide research synthesis. Despite this, penetration of these approaches into the social and environmental sciences has been limited. Here, we present an analysis of approaches for systematic review and research synthesis and examine their applicability in an adaptation context. Customized review frameworks informed by systematic approaches to research synthesis provide a conceptually appropriate and practical opportunity for increasing methodological transparency and rigor in synthesizing and tracking adaptation research. This review highlights innovative applications of systematic approaches, with a focus on the unique challenges of integrating multiple data sources and formats in reviewing climate change adaptation policy and practice. We present guidelines, key considerations, and recommendations for systematic review in the social sciences in general and adaptation research in particular. We conclude by calling for increased conceptual and methodological development of systematic review approaches to address the methodological challenges of synthesizing and tracking adaptation to climate change. [ABSTRACT FROM AUTHOR]

Adaptation is a key component of climate policy, yet we have limited and fragmented understanding of if and how adaptation is currently taking place. In this paper, we document and characterize the current status of adaptation in 47 vulnerable 'hotspot' nations in Asia and Africa, based on a systematic review of the peer-reviewed and grey literature, as well as policy documents, to extract evidence of adaptation initiatives. In total, 100 peer-reviewed articles, 161 grey literature documents, and 27 United Nations Framework Convention on Climate Change National Communications were reviewed, constituting 760 adaptation initiatives. Results indicate a significant increase in reported adaptations since 2006. Adaptations are primarily being reported from African and low-income countries, particularly those nations receiving adaptation funds, involve a combination of groundwork and more concrete adaptations to reduce vulnerability, and are primarily being driven by national governments, NGOs, and international institutions, with minimal involvement of lower levels of government or collaboration across nations. Gaps in our knowledge of adaptation policy and practice are particularly notable in North Africa and Central Asia, and there is limited evidence of adaptation initiatives being targeted at vulnerable populations including socioeconomically disadvantaged populations, children, indigenous peoples, and the elderly. [ABSTRACT FROM AUTHOR]

This paper applies a systematic approach to measuring adaptation actions being undertaken by 117 parties to the United Nations Framework Convention on Climate Change (UNFCCC) with the goal of establishing a baseline of global trends in adaptation. Data are systematically collected from National Communications prepared by Parties to the Convention and submitted periodically to the Secretariat. 4,104 discrete adaptation initiatives are identified and analyzed. Our findings indicate that while progress is being made on conducting impact and vulnerability assessments and adaptation research in nearly every country in the sample, translation of this knowledge into tangible adaptation initiatives is still limited. The largest number of reported adaptations falls under the category of infrastructure, technology, and innovation. Some types of vulnerability were more frequently reported across initiatives, including floods, drought, food and water safety and security, rainfall, infectious disease, and terrestrial ecosystem health. Notably, reporting on the inclusion of vulnerable sub-populations is low across all actions. Diffusion of adaptation across sectors remains underdeveloped, with the environment, water, and agricultural sectors emerging as the most active adaptors. Our analysis indicates that national communications provide a valuable source of information for global-scale adaptation tracking, but important gaps exist in the consistency of reporting that should be addressed, as these documents could greatly enhance efforts to monitor and evaluate adaptation progress. [ABSTRACT FROM AUTHOR]

This article provides a review and synthesis of scholarly knowledge of Depression-era droughts on the North American Great Plains, a time and place known colloquially as the Dust Bowl era or the Dirty Thirties. Recent events, including the 2008 financial crisis, severe droughts in the US corn belt, and the release of a popular documentary film, have spawned a resurgence in public interest in the Dust Bowl. Events of the Dust Bowl era have also proven in recent years to be of considerable interest to scholars researching phenomena related to global environmental change, including atmospheric circulation, drought modeling, land management, institutional behavior, adaptation processes, and human migration. In this review, we draw out common themes in terms of not only what natural and social scientists have learned about the Dust Bowl era itself, but also how insights gained from the study of that period are helping to enhance our understanding of climate-human relations more generally. [ABSTRACT FROM AUTHOR]

That the climate is changing and societies will have to adapt is now unequivocal, with adaptation becoming a core focus of climate policy. Our understanding of the challenges, needs, and opportunities for climate change adaptation has advanced significantly in recent years yet remains limited. Research has identified and theorized key determinants of adaptive capacity and barriers to adaptation, and more recently begun to track adaptation in practice. Despite this, there is negligible research investigating whether and indeed if adaptive capacity is translating into actual adaptation action. Here we test whether theorized determinants of adaptive capacity are associated with adaptation policy outcomes at the national level for 117 nations. We show that institutional capacity, in particular measures of good governance, are the strongest predictors of national adaptation policy. Adaptation at the national level is limited in countries with poor governance, and in the absence of good governance other presumed determinants of adaptive capacity show limited effect on adaptation. Our results highlight the critical importance of institutional good governance as a prerequisite for national adaptation. Other elements of theorized adaptive capacity are unlikely to be sufficient, effective, or present at the national level where national institutions and governance are poor. [ABSTRACT FROM AUTHOR]

This essay examines the extent to which we can expect Indigenous Knowledge, understanding, and voices on climate change ('Indigenous content') to be captured in WGII of the IPCC Fifth Assessment Report (AR5), based on an analysis of chapter authorship. Reviewing the publishing history of 309 chapter authors (CAs) to WGII, we document 9 (2.9%) to have published on climate change and Indigenous populations and involved as authors in 6/30 chapters. Drawing upon recent scholarship highlighting how authorship affect structure and content of assessment reports, we argue that, unaddressed, this will affect the extent to which Indigenous content is examined and assessed. While it is too late to alter the structure of AR5, there are opportunities to prioritize the recruitment of contributing authors and reviewers with expertise on Indigenous issues, raise awareness among CAs on the characteristics of impacts, adaptation, and vulnerability faced by Indigenous peoples, and highlight how Indigenous perspectives can help broaden our understanding of climate change and policy interventions. [ABSTRACT FROM AUTHOR]

A survey documenting how climate change is perceived and responded to by Canadian mine operations was administered to a random sample of practitioners working at mine sites across Canada. Key findings include: (1) Mines are sensitive to climatic hazards; (2) There is concern about climate change among mine practitioners, but the majority have not yet noticed climate change to be affecting operations; (3) Future climate change is expected to have negative impacts for mine operations; (4) Mines are responding to climate change mainly through efforts to reduce greenhouse gas emissions but also through adaptation, although to a lesser degree; and (5) Knowledge of future climate change projections and impacts is limited, potentially constraining understanding of the nature of climate change risks. The survey compliments previous work documenting perceptions among upper level management on climate change in the Canadian mining industry. The results from both surveys are largely consistent, establishing that the mining sector perceives climate change as an emerging risk and is developing response options, but needs to invest more time and resources for adaptation to what are inevitable changes in climate. The results support the need for targeted in-depth research to assess the vulnerability of mining to climate change and to evaluate response options. [ABSTRACT FROM AUTHOR]

We develop and apply a systematic mixed-methods literature review methodology to identify and characterize how climate change adaptation is taking place in developed nations. We find limited evidence of adaptation action. Where interventions are being implemented and reported on, they are typically in sectors that are sensitive to climate impacts, are most common at the municipal level, facilitated by higher-level government interventions, with responses typically institutional in nature. There is negligible description of adaptation taking place with respect to vulnerable groups, with reporting unequal by region and sector. The methodology offers important insights for meta-analyses in climate change scholarship and can be used for monitoring progress in adaptation over time. [ABSTRACT FROM AUTHOR]

Climate is an important component of the operating environment for the Canadian mining sector. However, in recent years mines across Canada have been affected by significant climatic hazards, several which are regarded to be symptomatic of climate change. For the mining sector, climate change is a pressing environmental threat and a significant business risk. The extent to which the mining sector is able to mitigate its own impact and adapt to climate change will affect its long-term success and prosperity, and have profound economic consequences for host communities. This paper draws upon case studies conducted with mining operations in Canada involving in-depth interviews with mining professionals and analysis of secondary sources to characterize the vulnerability of the Canadian mining industry to climate change. Five key findings are discussed: i) mines in the case studies are affected by climate events that are indicative of climate change, with examples of negative impacts over the past decade; ii) most mine infrastructure has been designed assuming that the climate is not changing; iii) most industry stakeholders interviewed view climate change as a minor concern; iv) limited adaption planning for future climate change is underway; v) significant vulnerabilities exist in the post-operational phase of mines. This paper argues for greater collaboration among mining companies, regulators, scientists and other industry stakeholders to develop practical adaptation strategies that can be integrated into existing and new mine operations, including in the post-operational phase. [ABSTRACT FROM AUTHOR]

This paper reviews scientific and gray literature addressing climate change vulnerability and adaptation in the Inuvialuit Settlement Region (ISR) in the western Canadian Arctic. The review is structured using a vulnerability framework, and 420 documents related directly or indirectly to climate change are analyzed to provide insights on the current state of knowledge on climate change vulnerability in the ISR as a basis for supporting future research and long-term adaptation planning in the region. The literature documents evidence of climate change in the ISR which is compromising food security and health status, limiting transportation access and travel routes to hunting grounds, and damaging municipal infrastructure. Adaptations are being employed to manage changing conditions; however, many of the adaptations being undertaken are short term, ad-hoc, and reactive in nature. Limited long-term strategic planning for climate change is being undertaken. Current climate change risks are expected to continue in the future with further implications for communities but less is known about the adaptive capacity of communities. This review identifies the importance of targeted vulnerability research that works closely with community members and decision makers to understand the interactions between current and projected climate change and the factors which condition vulnerability and influence adaptation. Research gaps are identified, and recommendations for advancing adaptation planning are outlined. [ABSTRACT FROM AUTHOR]

Sleeping sickness continues to be a significant public health burden in southeastern Uganda. Continued spread of the disease into new areas of Uganda highlights our inability to understand and predict the distribution of infection. Multiple factors influence the distribution of sleeping sickness, including climate, land cover, cattle movements, prevention and control activities, and social conflict. We draw on a systems approach to conceptualize and characterize the multiple interacting forces and processes that influence the spatial and temporal dynamics of sleeping sickness in Uganda. This synthesis reveals a complex system of interactions among human and biophysical systems, feedback, and scale dependence. We identify some common analytical modeling approaches relative to our system characterization and identify opportunities for sleeping sickness research and improved understanding of disease dynamics in Uganda. [ABSTRACT FROM AUTHOR]

Objectives: Among older Canadians, we examined the influence of low social support, a weak sense of belonging, and living alone to understand their role on mortality risk in Canada., Methods: We conducted a retrospective cohort study of older Canadians surveyed in 2001 from the Canadian Community Health Survey and followed up with death events through December 31, 2011 from the Canadian Vital Statistics Database. Analyses were stratified by age: 55-64 and 65 and older. Social support was assessed using measures developed for the Medical Outcomes Study. A sense of belonging, a binary measure, measured community integration. Living alone was a binary measure. Survival analysis was applied using a Cox proportional hazards model, adjusted for age, sex, income, smoking, and frailty., Results: Among respondents 55-64 (n = 6822), low affection (HR = 1.37; 95% CI 1.07, 1.75), low emotional/informational support (HR = 1.36; 95% CI 1.06, 1.74), and low positive social interactions (HR = 1.36; 95% CI 1.06, 1.75) were associated with mortality risk. Among respondents 65 and older (n = 8966), low affection (HR = 1.17; 95% CI 1.04, 1.31), low positive social interactions (HR = 1.20; 95% CI 1.07, 1.34), low emotional/informational support (HR = 1.19; 95% CI 1.06, 1.33), and a weak sense of belonging (HR = 1.13; 95% CI 1.05, 1.22) were associated with mortality risk., Conclusion: Low social support and a weak sense of belonging are important risk factors among older Canadians and should be part of the dialogue in Canada about their roles in healthy aging.