As the 28th United Nations Climate Change Conference of Parties (COP 28) begins in Dubai, we are pleased to release a new report, A Global Review of Research on Effective Advocacy and Communication Strategies at the Intersection of Climate Change and Health. To produce this report, we reviewed and synthesized the findings from all 195 peer-reviewed research studies published on this topic between January 2000 and July 2023 in English, Chinese, French, German, Japanese, Korean, Portuguese, and Spanish.
Key findings from the report include:
- In many countries around the world, including the U.S., the public knows relatively little about the health relevance of climate change but informing them—about impacts, solutions, and supportive social norms—holds significant promise for increasing public engagement with the issue and building support for climate solutions.
- In countries worldwide, health professionals are trusted voices who can deliver this information, and many health professionals welcome this and related climate advocacy roles.
- Health professionals have necessary and unique opportunities to build public and political will for societal responses to the climate crisis—as a health crisis.
- These findings must be considered tentative due to the sparseness of the evidence from many countries, especially in the Global South.
In this review, we summarize research on the understanding of the health impacts of climate change among the public, health professionals, and public officials, outline effective strategies to communicate these impacts and future risks, and advocate for solutions to reduce these risks. The primary objective of this literature review is to leverage existing research to identify practical recommendations for effectively communicating the health risks linked to climate change and the health benefits of climate solutions. We also identify potential avenues for further investigation in this important field.
A previous version of this review developed for the World Health Organization focused on English-language studies identified through Google Scholar. With support from the Wellcome Trust, this expanded and revised edition includes non-English language studies and additional research found in three other English-language databases, focusing primarily on studies published between 2000 and July 2023. Specifically, this report covers relevant research published in English, Chinese, French, German, Japanese, Korean, Portuguese, and Spanish. To accomplish this, we conducted a literature search across several databases, including PubMed, Web of Science, ScienceDirect, Google Scholar, SciELO, CnKi, Erudite, J-Stage, Korean Citation Index, and CyberLeninka, selected for their extensive coverage of social science research on an international scale. The selection of relevant non-English language databases was determined in consultation with a research librarian.
To screen the search results, we established specific inclusion and exclusion criteria, which can be found in the Methods section (page 46). These criteria served as the basis for identifying a total of 182 English-language studies and 13 non-English-language studies. A list of the articles reviewed, the language in which they were published, their geographical scope, and information on the populations sampled can be found in Appendix 1. Within each section of the review, we discuss the strength and geographical scope of the available evidence base. Additional details about the methods can be found in Section 13.
Following typical literature review practice, we conducted a narrative synthesis of the studies identified in the review studies. These studies provide insights into the perspectives of public audiences, health professionals, and public officials on climate change and health. A complementary scholarly publication based on the evidence in this report is under development and will be published in a peer-reviewed journal at a future date.
Based on existing research, the majority of which has been carried out in the Global North with few exceptions, we find that providing information about the health relevance of climate change holds significant promise for increasing public engagement with the issue and building greater support for climate solutions.We also find that health professionals are trusted voices to deliver this information, and that many health professionals would welcome this and related climate advocacy roles.
Our findings also suggest that public officials worldwide possess varying levels of understanding of the health consequences of climate change, underscoring the need to strengthen their knowledge and willingness to actively engage in addressing climate change and its associated health impacts. Specific findings from each section of the report are detailed below.
Globally, there has been surprisingly little research to assess public understanding of the health risks and impacts of climate change, although the evidence base is growing. In the USA, Canada, and the UK, where most research has been conducted, studies suggest that there is increasing recognition that climate change causes multiple threats to human health, although few are able to name specific ways in which climate change harms health. Perceptions of the health impacts of climate change vary considerably from country to country.
Drawing definitive conclusions about public perceptions in many regions of the world remains challenging due to the scarcity of high-quality, representative survey data. Many studies rely on limited sample sizes or narrow their focus to specific cities or subnational regions within a country. Consequently, more research is needed to gain a comprehensive understanding of public awareness regarding the health impacts of climate change, particularly in non-Western contexts.
Research conducted in China, Germany, India, UK, and USA strongly suggests that framing climate change as a public health issue can be an effective way to enhance public engagement with the issue and generate support for pro-climate policies and action. Further, health-framed messaging can be particularly valuable in increasing support for climate action across the political spectrum, including among those who tend to be less concerned about climate change. Given that people from all political backgrounds tend to care about health, highlighting the health risks of climate change and the health benefits of climate solutions can help make the issue of climate change less politically divisive. Furthermore, a multinational study conducted with participants from China, Germany, India, UK, and USA found that a health frame is generally more effective when positively valenced (focusing on the benefits of action), and discussed as a global-scale issue that is affecting people now as opposed to far off in the future. While the evidence for the effectiveness of framing climate change as a health issue is largely positive, a few studies show null or counterproductive effects under certain conditions, such as when audiences have difficulty identifying with the people being impacted by climate change, and when they are simultaneously exposed to messaging that opposes action on climate change. Moreover, research in the USA suggests highlighting climate-related risks to people’s personal health can sometimes be demobilizing by making them feel more vulnerable and therefore less capable of investing resources into actions to address climate change. Although more research is needed to better understand how to cultivate the full potential of such communication, it may be possible to address some of these limitations by helping audiences develop a sense of empathy for those affected by climate change, inoculating people by forewarning them about misinformation used in oppositional messaging, and providing people with a greater sense of self-efficacy by talking about the health benefits of climate and health solutions.
Research conducted primarily in the USA suggests that informing people about the health harms of climate change and the burning of fossil fuels can increase their concern about the issue, support for clean energy use, and willingness to advocate for climate policies with elected officials, making it an important first step for building public and political will for climate action. Information specifically about the neurological harms to children from exposure to air pollution appears to be especially engaging among Americans across partisan lines. A multinational study found that in Germany, a more negative focus on the health threat of climate change increased support for climate change mitigation policies relative to a more positive message focused on the health benefits of climate action, whereas the opposite pattern was observed in other countries, including China, the UK, and the USA. While additional research would be helpful—especially beyond the United States—the existing evidence strongly suggests the value of communicating about the health harms of air pollution and climate change.
Research conducted in multiple countries, including the USA, UK, and China, find communicating about the health benefits of climate change solutions also appears to be an effective way to increase political engagement in support of pro-climate policies. Indeed, highlighting the health benefits of taking action (i.e., a gain frame) appears to be even more effective than highlighting the health risks of climate change (i.e., a loss frame)—although both are helpful, as is highlighting the social norm that most people are concerned about climate change. Solutions-focused messages may also help build climate policy support, mobilize people to engage in advocacy, and activate positive, motivating emotions, like hope. In addition, climate and health messages that first evoke fear and then follow up with hope-inspiring content may also strengthen people’s intentions to engage in climate advocacy. Future research should include different geographies and strengthen the evidence on the effectiveness of communication centered around the health benefits of climate solutions.
Unfortunately, there is limited research on communicating the inequities associated with climate change and health. Although some vulnerable populations may already perceive their health to be at risk because of climate change,
studies in the USA have shown that most Americans do not understand that climate change will have disproportionate impacts on some types of people’s health. Messaging that informs people about the disproportionate impacts of climate change on the health of the most vulnerable populations—including people in low-wealth communities, ethnic and racial minorities, women, children, people with chronic illnesses, and people who earn their livelihoods outdoors—may hold both promise and pitfalls. It may increase engagement among some audiences but may also have the paradoxical effect of undermining concern and support for action among audiences that are less vulnerable. Strategies that help people understand the health equity considerations associated with climate change should be informed by existing research and developed in consultation with members of vulnerable groups.
There has been little research on the use of climate and health visual imagery, although the existing evidence (primarily from the USA and UK) suggests that visuals depicting impacts of climate change heighten perceived issue importance, whereas visuals depicting solutions tend to enhance people’s belief in their capacity to engage in individual mitigation behaviors such as shifting to a climate-friendly diet. One UK-based study found that images depicting air pollution were more effective than images of floods, heat stress, and infectious diseases in generating both concern about climate change and enhanced self-efficacy. More research is needed to better understand how visual communication can be leveraged to enhance both issue importance and self-efficacy.
Although health professionals are viewed as one of the most trusted professions globally, less is known about public trust in them as sources of information about climate change. Recent research in the USA, however, found that Americans see their primary care doctor as a highly trustworthy source of information about global warming. Given this potential, additional context-based evidence could offer an opportunity to communicate effectively and urgently through trusted voices in the health care profession.
Globally, many health professionals have at least a general understanding of the fact that human-caused climate change is harmful to human health, although most also say they lack detailed knowledge. Globally, many health professionals also express interest in learning more about climate change and health, and about what they can do to be effective educators and advocates. A recent multi-national survey of health professionals found that understanding the health relevance of climate change and the extent of the scientific consensus about human-caused global warming are strongly associated with feeling that health professionals have a professional responsibility to engage in the issue. This perceived sense of responsibility, in turn, is strongly associated with health professionals’ willingness to engage in advocacy for policies to protect the climate and human health. As trusted sources of information and willing advocates for climate action, health professionals need the support and partnership of public officials and key stakeholders to be highly effective and impactful.
Collaborating with health professionals can ensure that their expertise informs policy decisions and that their messages resonate with a wider audience, contributing to improved climate change and health outcomes.
Health professionals from many countries, such as Canada, UK, India, Australia, New Zealand, and South Africa, show interest in addressing climate change through their clinical practice and in the public arena. As trusted voices, efforts by health professionals to set personal examples of climate-health action, to decarbonize the health care sector, and to advocate for climate-informed health policy, may be viewed as more credible. Emerging research suggests that climate and health policymaking could benefit from better dialogue between policymakers and health professionals. Multinational research has shown that interested health professionals experience—or at least perceive—barriers to their ability to engage. These include the lack of knowledge, resources, and time, a range of social challenges including issue polarization, fear of damaging professional relationships, and the perceived lack of peer support. Despite evidence of interest from students of health professions from China, the USA, Canada, Finland, and Australia in climate-focused coursework, such curricula are rare. Developing climate and health content for such curricula will require tailored assessments of needed programming and any barriers to adding new educational material. Implementing various strategies—such as providing education and communication trainings, creating resources like patient education materials to incorporate into existing practitioner routines and policy briefs, giving actionable guidelines on how to achieve climate-friendly health workplaces, promoting workplace and professional policies and cultures that encourage and support advocacy, and providing training to engage in high-impact political advocacy actions—may help reduce these barriers and make it easier for health professionals to collaborate and engage in climate education and advocacy.
Although there is limited evidence, research suggests that public officials display varying levels of knowledge about climate-related health threats. While some exhibit an awareness of the issue, others express uncertainty or a lack of knowledge often influenced by barriers like funding availability, absence of strong leadership, and legal mandates. Advocates should seek to better understand such barriers in order to develop strategies to help alleviate them. Searching for case studies where other organizations have addressed such barriers effectively would serve as a useful model.
In the USA, there is evidence of polarization around beliefs about regional climate and health impacts among local health department directors. Further, two other US studies found that majorities of public health officials do not believe that climate change is currently a priority for their department. Advocates should learn what issues are perceived as priorities for health officials so that they can help them consider how climate change may be linked to those issues and how best to be responsive to such concerns.
These findings highlight the need for education and communication efforts to enhance public officials’ engagement with climate change and health; however, there is little systematic research on how to do so effectively. One potential strategy is to increase public engagement with climate change and health and strengthen opportunities for constituents to signal their concern to public officials in order to give officials a stronger mandate to prioritize the issue and take more ambitious actions.
Uppalapati, S., Ansah, P., Campbell, E., Gour, N., Thier, K., Kotcher, J., & Maibach, E. (2023). A global review of research on effective advocacy and communication strategies at the intersection of climate change and health. George Mason University. DOI: 10.31219/osf.io/6w3qh
We thank Wellcome Trust for funding this research.