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Abstract Conflict and war have long been recognized as determinants of infectious disease risk. Re-emergence of epidemic sleeping sickness in sub-Saharan Africa since the 1970s has coincided with extensive civil conflict in affected regions. Sleeping sickness incidence has placed increasing pressure on the health resources of countries already burdened by malaria, HIV/AIDS, and tuberculosis. In areas of Sudan, the Democratic Republic of the Congo, and Angola, sleeping sickness occurs in epidemic proportions, and is the first or second greatest cause of mortality in some areas, ahead of HIV/AIDS. In Uganda, there is evidence of increasing spread and establishment of new foci in central districts. Conflict is an important determinant of sleeping sickness outbreaks, and has contributed to disease resurgence. This paper presents a review and characterization of the processes by which conflict has contributed to the occurrence of sleeping sickness in Africa. Conflict contributes to disease risk by affecting the transmission potential of sleeping sickness via economic impacts, degradation of health systems and services, internal displacement of populations, regional insecurity, and reduced access for humanitarian support. Particular focus is given to the case of sleeping sickness in south-eastern Uganda, where incidence increase is expected to continue. Disease intervention is constrained in regions with high insecurity; in these areas, political stabilization, localized deployment of health resources, increased administrative integration and national capacity are required to mitigate incidence. Conflict-related variables should be explicitly integrated into risk mapping and prioritization of targeted sleeping sickness research and mitigation initiatives.

Rift Valley fever virus (RVFV) is an arthropod-borne disease resulting in severe morbidity and mortality in both human and ruminant populations. First identified in Kenya in 1930, the geographical range of RVFV has been largely constrained to the African continent, yet has recently spread to new regions, and is identified as a priority disease with potential for geographic emergence. We present a systematic literature review assessing the potential for RVFV introduction and establishment in the United States (US) and European Union (EU). Viable pathways for the introduction of RVFV include: transport of virus-carrying vectors, importation of viremic hosts and intentional entry of RVFV as a biological weapon. It is generally assumed that the risk of RVFV introduction into the US or EU is low. We argue that the risk of sporadic introduction is likely high, though currently an insufficient proportion of such introductions coincide with optimal environmental conditions. Future global trends may increase the likelihood of risk factors for RVFV spread.

For emerging public health risks such as climate change, the Canadian federal government has a mandate to provide information and resources to protect citizens' health. Research is a key component of this mandate and is essential if Canada is to moderate the health effects of a changing climate.

AbstractAlthough governments are developing and implementing policies to adapt to the impacts of climate change, it remains unclear which factors shape how states are developing these policies. This paper aims to assess whether or not administrative traditions matter for the formation of national climate change adaptation policy in 32 high‐income countries. We operationalize administrative traditions based on five structural criteria: vertical dispersion of authority, horizontal coordination, interest mediation between state‐society, role of public administrator, and how ideas enter bureaucracy. We construct a unique adaptation policy dataset that includes 32 high‐income countries to test seven hypotheses. Our results indicate that countries' adaptation policies align to some extent with their administrative structure, particularly dispersion of authority and horizontal coordination. However, we find limited evidence that other public bureaucracy factors are related to national adaptation policy. We conclude that administrative traditions matter, but that their influence should not be overestimated.

Sleeping sickness is a parasitic, vector-borne disease, carried by the tsetse fly and prevalent in sub-Saharan Africa. The disease continues to pose a public health burden in Uganda, which experienced a widespread outbreak in 1900-1920, and a more recent outbreak in 1976-1989. The disease continues to spread to uninfected districts. This paper compares the spatial distributions of sleeping in Uganda for the 1900-1920 outbreak period with current disease foci, and discusses information gaps and implications arising for future research, prevention and control. Population census records for 1911 and sleeping sickness records from Medical and Sanitary Reports of the Ugandan Protectorate for 1905-1936 were extracted from the Uganda Archives. Current sleeping sickness distribution data were provided by the Ministry of Health, Uganda. These were used to develop sleeping sickness distribution maps for comparison between the early 1900s and the early 2000s. The distribution of sleeping sickness from 1905-1920 shows notable differences compared to the current distribution of disease. In particular, archival cases were recorded in south-west and central Uganda, areas currently free of disease. The disease focus has moved from lakeshore Buganda (1905-1920) to the Busoga and south-east districts. Archival sleeping sickness distributions indicate the potential for a much wider area of disease risk than indicated by current disease foci. This is compounded by an absence of tsetse distribution data, continued political instability in north-central Uganda, continued spread of disease into new districts, and evidence of the role of livestock movements in spreading the parasite. These results support concerns as to the potential mergence of the two disease foci in the south-east and north-west of the country.

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.

Climate change is a major challenge facing public health. National governments play a key role in public health adaptation to climate change, but there are competing views on what responsibilities and obligations this will—or should—include in different nations. This study aims to: (1) examine how national-level public health adaptation is occurring in Organization for Economic Cooperation and Development (OECD) countries; (2) examine the roles national governments are taking in public health adaptation; and (3) critically appraise three key governance dimensions of national-level health adaptation—cross-sectoral collaboration, vertical coordination and national health adaptation planning—and identify practical examples suited to different contexts. We systematically reviewed publicly available public health adaptation to climate change documents and webpages by national governments in ten OECD countries using systematic web searches, assessment of self-reporting, and content analysis. Our findings suggest national governments are primarily addressing infectious disease and heat-related risks posed by climate change, typically emphasizing capacity building or information-based groundwork initiatives. We find national governments are taking a variety of approaches to public health adaptation to climate change that do not follow expected convergence and divergence by governance structure. We discuss practical options for incorporating cross-sectoral collaboration, vertical coordination and national health adaptation planning into a variety of contexts and identify leaders national governments can look to to inform their public health adaptation planning. Following the adoption of the Paris Agreement and subsequent increased momentum for adaptation, research tracking adaptation is needed to define what health adaptation looks like in practice, reveal insights that can be taken up across states and sectors, and ensure policy orientated learning.

Extreme heat events impact people and ecosystems across the globe, and they are becoming more frequent and intense in a warming climate. Responses to heat span sectors and geographic boundaries. Prior research has documented technologies or options that can be deployed to manage extreme heat and examples of how individuals, communities, governments and other stakeholder groups are adapting to heat. However, a comprehensive understanding of the current state of implemented heat adaptations—where, why, how and to what extent they are occurring—has not been established. Here, we combine data from the Global Adaptation Mapping Initiative with a heat-specific systematic review to analyze the global extent and diversity of documented heat adaptation actions (n = 301 peer-reviewed articles). Data from 98 countries suggest that documented heat adaptations fundamentally differ by geographic region and national income. In high-income, developed countries, heat is overwhelmingly treated as a health issue, particularly in urban areas. However, in low- and middle-income, developing countries, heat adaptations focus on agricultural and livelihood-based impacts, primarily considering heat as a compound hazard with drought and other hydrological hazards. 63% of the heat-adaptation articles feature individuals or communities autonomously adapting, highlighting how responses to date have largely consisted of coping strategies. The current global status of responses to intensifying extreme heat, largely autonomous and incremental yet widespread, establishes a foundation for informed decision-making as heat impacts around the world continue to increase. ; Environmental Science and Policy