An Assessment Framework of Adaptive Capacity to Multi-hazard Climate Health Risks and Its Application in China

Climate change has posed significant health risks to human health and stimulated global attention to climate health adaptation. Wherein, assessing climate health adaptive capacity (AC) is fundamental for designing adaptation strategies and monitoring adaptation progress. However, existing assessment frameworks mainly took into account material determinants like economic resources and infrastructure but lacked consideration of non-material ones such as adaptation institutions, climate health knowledge, and social equity. Meanwhile, the majority of assessments only focus on health risks of one specific climate hazard like heatwaves or floods, with few considering multiple hazards simultaneously. Given the different climate health risks and disparities in socioeconomic development levels among provinces, it is meaningful to carry out the assessment at the provincial level in China, where no previous study on climate health AC has been done before. We aim to design a comprehensive assessment framework on AC with considerations on multi-hazard climate health risks and non-material determinants, and apply this framework in China. We build an index-based assessment framework for AC to multi-hazard climate health risks based on six determinants: institutions, economic resources, infrastructure, science & technology, knowledge, and equity. Using the Fuzzy Comprehensive Evaluation method, we calculate AC for 31 provinces in China (excluding Hong Kong, Macao, and Taiwan) in 2012–2022 and analyze spatial-temporal patterns of AC and its determinants. We find that high-AC provinces were Beijing, Shanghai, Jiangsu, and Zhejiang–relatively affluent–while low-AC ones were Yunnan, Tibet, and Qinghai–relatively impoverished. In 2012–2022, overall AC has gradually increased, it was driven by improvements of institutions and economic resources, whereas contributions from science & technology and knowledge were limited. Spatially, AC exhibited “strong in the east, weak in the west” and “strong in the coastal, weak in the inland”. The spatial disparities have increased overall between the east and west, while decreased slightly in 2020–2022. It was caused by disparities in institutions, economic resources, and equity across provinces. Based on findings above, on the one hand, due to significant provincial disparities in climate health risks, enhancing AC highly relies on knowledge and scientific analysis of risk characteristics and local socioeconomic conditions. Thus, it is essential to leverage potential of climate health science & technology, as well as scientific and local knowledge to further enhance AC in the future. On the other hand, the provincial inequality of AC may lead to insufficient response to climate health risks in western inland provinces, and also drag the overall health adaptation process of China. Efforts should be addressed on these institutions, economic resources, and equity to promote regional coordinated enhancement of AC including environmental health risk assessments, investment in climate health adaptation, and accessibility of public health services.