Local research evidence for public health interventions against climate change in Vietnam

T he determinants of health and well-being include a wide range of environmental and social factors. Increasingly recognized drivers of injuries and illhealth are the consequences of changing weather patterns, climate extremes, and climate change. The evidence of such effects is, however, under-researched in lowand middle-income countries. For the majority of studies, originating from high-income settings, the context is considerably different. Understanding the risks better and how to manage them, from a local to a global scale, is key to future sustainable development and effective health protection policies. The domains of health risks from climate variability and change have been described in the latest assessment report from the Intergovernmental Panel on Climate Change and summarized in a recent paper (1); these include morbidity and mortality from extreme weather and climate events, infectious diseases, under-nutrition associated with changing weather patterns, and respiratory diseases associated with exposure to aeroallergens, ozone, or particulate matter. Evidence is needed of the associations between weather and health to understand the potential negative impacts of climate variability and change; to inform adaptation strategies to prepare for, cope with, and recover from climate-change-related impacts; and to underpin local and global policies to reduce greenhouse gas emissions. Evidence and projections of the health risks of climate change are needed at all temporal scales, starting with observational evidence of the health consequences of recent changes in weather patterns. At the seasonal scale, increased understanding of climate variability, and its influence on societies and public health, is offering opportunities to develop early warning systems to protect human health. Over the longer term, model projections are needed of how climate and development patterns could interact to influence the geographic range, alter historic seasonal patterns of disease, and affect the intensity of climate-sensitive health burdens. Thus, modeling can provide essential insights into how the greenhouse gas emissions of today may affect future public health and welfare. Local health impact evidence can be a powerful tool in creating local public opinion and mandate to climate change mitigation. Evidence across all geographical and temporal scales are largely missing for lowand middle-income countries, limiting the understanding of the magnitude and pattern of the associations between weather and climate with health outcomes. This lack of evidence means that health protection programs are typically top down lead initiatives, such as regional disaster management plans and national climate change adaptation policy recommendations (where they exist). Although such initiatives are extremely important, health protection and climate change adaptation is an iterative process between stakeholder groups at local to international levels to ensure that policies and programs take the local context into account, thus facilitating greater efficacy and uptake. However, researchers are largely absent from these discussions, and the competence, capacity, and economic incentives for research training have been limited so far (2). Vietnam is a country whose economy is growing strongly, with distinct demographic and epidemiological transitions and urbanization. It is characterized by large heterogeneity in the populations, with significant urban Global Health Action