Global analysis of climate adaptation policies for promoting environmentally sustainable, decarbonised health systems: a scoping review

Thesis

Background: Climate change threatens human health and strains health systems, which must cut GHG emissions and boost resilience. While progress occurs in HICs, LMICs lack similar initiatives, limiting comparative analysis. There is little empirical evidence on climate adaptation (CA) policies and enablers, especially in LMICs. This thesis aims to address this gap by reviewing literature on global CA policies and enablers for sustainable, decarbonised health systems.

Method: A scoping review of peer-reviewed and grey literature from 2005 to 2025 was conducted, following the guidelines of Arksey and O’Malley, Levac et al., and JBI. Six databases (PubMed, Web of Science, Scopus, JBI database, Overton, and WHO Global Index Medicus) were searched with relevant keywords. A deductive framework analysis mapped CA policies against the WHO’s Operational Framework and their enablers to the Ottawa Charter for Health Promotion. The protocol was registered on Open Science Framework. PRISMA-ScR and scoping review guidelines were adhered to.

Results: Out of 2,632 studies, 26 studies met the inclusion criteria. 80% were published between 2023 and 2025, 42% from HICs, and 39% were original research. All 26 studies discussed ‘leadership and governance’, the most addressed component. Only 12% discussed ‘managing environmental determinants of health’. The most common enabler addressed, related to the Ottawa Charter, was ‘building healthy public policy’, and the least was ‘strengthening community action’. No studies from Nigeria or on the evaluation or implementation costs of CA policies.

Conclusion: This review highlights gaps in CA policy evidence for sustainable, decarbonised health systems, stressing the need for more research across geopolitical contexts, sharing lessons, and real-world experiences. This will help shift from fragmented efforts to comprehensive strategies that build resilience and support decarbonisation and transformative health system change. Keywords – , resilience, health systems, health promotion, net zero, Nigeria, Ottawa charter, Building blocks

Authors: Fasominu, O

• DOI: 10.5287/ora-qzo5qb9y6
• Type of award: MSc
• Level of award: Masters
• Awarding institution: University of Oxford
• Language: English
• Keywords: net zero; building blocks; climate adaptation; Nigeria; Ottawa Charter; resilience; health promotion; health systems
• Subjects: Climate change adaptation; Health; Policy, Government; Climate; Resilience (Ecology)