By David Richards
Thousands of global health academics and practitioners from around the world convened for the Consortium of Universities for Global Health's (CUGH) twelfth annual conference held virtually on March 12-14, 2021. This year's conference centered on the theme, "Addressing Critical Gaps in Global Health and Development." In addition to the annual conference, researchers from across the National Institutes of Health participated in several satellite sessions, which began on March 1 prior to the start of the main conference. These satellite sessions provided targeted discussions on social determinants of health, infectious diseases, implementation science, and more. NIEHS' GEH program organized one session, "Closing the gap between knowledge and practice: implementation science priorities for health adaptation for climate change," held on March 9.
Moderated by NIEHS Senior Advisor John Balbus, M.D., M.P.H., this three-part session brought together climate and health researchers, public health practitioners, and implementation science experts to discuss how implementation science might inform climate health adaptation and identify challenges and priority research topics.
Implementation Science and Climate Adaptation
The National Cancer Institute (NCI) defines implementation science as "the study of methods to promote the adoption and integration of evidence-based practices, interventions, and policies into routine health care and public health settings to improve our impact on population health."
"The promise of any effective innovation that our science delivers can only be fully realized by a range of stakeholders," said panelist Gila Neta, epidemiologist and program director for Implementation Science at NCI. "We see implementation science as bridging the gap between research and practice and policy by building a knowledge base on how evidence can be most effectively communicated and integrated into practice."
Neta explained that within the field of implementation science, there is dissemination and implementation research. Dissemination research focuses on how and by whom evidence spreads, while implementation research focuses on the strategies that facilitate the adoption and integration of that evidence. Taken together, these processes help stakeholders ensure that their interventions have the intended benefits. For example, implementation science can improve the execution of national and state-level climate vulnerability planning or early warning systems for natural disasters and climate-sensitive diseases.
Other opening session speakers described aspects of climate health adaptation and how implementation science might be applied in the context of their work. Daniel Buss, Ph.D., advisor on climate change and health at the Pan American Health Organization, and Elena Villalobos Prats, M.P.H., technical officer at the World Health Organization, spoke about climate resilient health systems. Kristie Ebi, Ph.D., professor at the University of Washington, explained ways stakeholders can leverage implementation science to promote health system adaptation.
"We need to close the research gap between research and practice, so that we can start scaling up best practices and lessons learned," said Ebi. "We need to do this in a co-designed process, so that we make sure we take into account the considerations of the local context and what makes something easier or harder in a particular location."
Implementation Challenges Case Studies
The second part of the session illustrated implementation challenges through case studies. The case studies, particularly those on early warning systems, revealed a common theme that in many instances, stakeholders did not always accept an intervention.
A case study from Barbados found that shifting priorities at the Barbados Meteorological Service and technical capacity challenges at the Barbados Ministry of Health made it difficult to translate seasonal forecast models predicting dengue risk into public health action. In a case study from Peru, adopting an early warning system for malaria proved difficult because the researchers underestimated the overburdened nature of the Peruvian health system.
"The health system is overburdened at every level such that in order to transfer technology, they do not have the extra staff to take it on," said William Pan, Ph.D., professor at Duke University. "That was something we thought we would be able to work through, but that was a poor assumption. We are learning that the ability to take on a new technology in a government health ministry requires a full commitment."
Case Studies: Implementation Challenges for Health Adaptation
- Malaria Early Warning Systems in Ethiopia by Mike Wimberly, University of Oklahoma
- Diminishing Dengue with Climate Services in the Indo-Pacific by Limb Hapairai, Pacific Island Health Officers Association
- Early Warning Systems for Malaria in Peru by William Pan, Duke University
- Dengue Early Warning System in Barbados by Leslie Rollock, Ministry of Health, St. Michael, Barbados, and Rachel Lowe, London School of Hygiene and Tropical Medicine
- Adaptation Planning in Uttar Pradesh or Other States in India by Meena Sehgal, The Energy and Resources Institute, Nitish Dogra, International Institute of Health Management Research, and Anand Krishnan, All India Institute of Medical Sciences
- Adaptation Planning for Climate and Health in the Caribbean by Maureen Lichtveld, University of Pittsburgh
Opportunities for Implementation Science
The satellite session concluded with a statement from Virginia Murray, M.B.B.S., consultant in global disaster risk reduction for Public Health England prompting an open discussion among Murray, Balbus, Lindsey Martin, Ph.D., health scientist administrator at NIEHS, Anna Stewart-Ibarra, Ph.D., M.P.A., scientific director of the Inter-American Institute for Global Change Research, and Sadie Ryan, Ph.D., professor at the University of Florida.
The panel considered a range of topics, including the lessons learned from the COVID-19 pandemic to inform climate adaptation interventions, the importance of international cooperation, the role of behavioral science to complement implementation science, and the value of soft skills, such as communications and diplomacy.
"The science has to be useful, usable, and used," said Murray. The panelists echoed that the desired outcome of any evidenced-based research is to inform stakeholders' ability to enact policies and interventions. Implementation and behavioral sciences that utilize soft and transdisciplinary skills can not only improve the science process, but also help inform international, state, and local stakeholders. Health adaptation for climate change is gaining traction on an international level but still faces challenges on state and local levels.
"We are beginning to see international agencies line up to support public health programming for climate change in a very powerful and important way," said Balbus. "We see frameworks and inclusion of public health in the Sendai Framework, the upcoming 2021 United Nations Climate Change Conference in Glasgow, and the joint World Meteorological Organization/World Health Organization office for climate and health. However, we will also need a bottom-up approach to fully achieve change on the ground."
Related Links: Martin recently participated in an NIEHS podcast episode on implementation science.
