The need to assess and measure how social vulnerability influences the health impacts of climate change has resulted in a rapidly growing body of research literature. To date, there has been no overarching, systematic examination of where this evidence is concentrated and what inferences can be made. This scoping review provides an overview of studies published between 2012 and 2022 on social vulnerability to the negative health effects of climate change. Of the 2115 studies identified from four bibliographic databases (Scopus, Web of Science, PubMed, and CAB Direct), 230 that considered indicators of social vulnerability to climate change impacts on health outcomes were selected for review. Frequency and thematic analyses were conducted to establish the scope of the social vulnerability indicators, climate change impacts, and health conditions studied, and the substantive themes and findings of this research. 113 indicators of social vulnerability covering 15 themes were identified, with a small set of indicators receiving most of the research attention, including age, sex, ethnicity, education, income, poverty, unemployment, access to green and blue spaces, access to health services, social isolation, and population density. The results reveal an undertheorisation and few indicators that conceptualise and operationalise social vulnerability beyond individual sociodemographic characteristics by identifying structural and institutional dimensions of vulnerability, and a preponderance of social vulnerability research in high-income countries. This Review highlights the need for future research, data infrastructure, and policy attention to address structural, institutional, and sociopolitical conditions, which will better support climate resilience and adaptation planning.

Recent crises have underscored the importance that housing has in sustaining good health and, equally, its potential to harm health. Considering this and building on Howden-Chapman’s early glossary of housing and health and the WHO Housing and Health Guidelines, this paper introduces a range of housing and health-related terms, reflecting almost 20 years of development in the field. It defines key concepts currently used in research, policy and practice to describe housing in relation to health and health inequalities. Definitions are organised by three overarching aspects of housing: affordability (including housing affordability stress (HAS) and fuel poverty), suitability (including condition, accessibility and sustainable housing) and security (including precarious housing and homelessness). Each of these inter-related aspects of housing can be either protective of, or detrimental to, health. This glossary broadens our understanding of the relationship between housing and health to further promote interdisciplinarity and strengthen the nexus between these fields.

Objective To determine whether the Perx app improves medication adherence and clinical outcomes over 12 months compared with standard care in patients requiring polypharmacy. Design Randomised controlled trial with 12-month follow-up. Setting Outpatient clinics in three tertiary hospitals in Sydney, Australia. Participants Eligible participants were aged 18–75 years, with at least one chronic condition, taking ≥3 different medications (oral medications or injections), with smartphone accessibility. Participants were randomised in a 1:1 ratio. Interventions The intervention group used the Perx app that contained customised reminders and gamified interactions to reward verified medication adherence. Main outcome measures The primary outcome was medication adherence over 12 months measured using pill counts. Secondary outcomes included clinical outcomes (haemoglobin A1c (HbA1c), cholesterol, blood glucose, triglycerides, creatinine, thyroid function, blood pressure and weight). Results Of 1412 participants screened for eligibility, 124 participants were randomised; 45 in the Perx arm and 40 in the control arm completed the study. The average age was 59.5, 58.9% were women, chronic conditions were cardiovascular disease (78%), type 2 diabetes (75%), obesity (65%) or other endocrine disorders (18%). On average, participants were taking six medications daily. The Perx group had greater improvements in adherence at month 2 (Coef. 8%; 95% CI 0.01 to 0.15), month 3 (Coef. 7%; 95% CI 0.00 to 0.14) and month 12 (Coef. 7%; 95% CI 0.00 to 0.13). The probability of HbA1c ≤6.5% was greater in the Perx group at months 9 and 12 and cholesterol (total and low-density lipoprotein cholesterol) was lower in the Perx group at month 3. The intervention was particularly effective for those with obesity, taking medications for diabetes and taking ≤4 medications. Conclusions This study provides evidence that app-based behavioural change interventions can increase medication adherence and produce longer-term improvements in some clinical outcomes in adults managing multimorbidity. More trials are needed to build the evidence base. Trial registration number ACTRN12617001285347.

Extreme weather and climate-related disaster events are associated with a range of adverse health outcomes. People are not equally vulnerable to the adversity, experiencing varied patterns of long-term health trajectories in recovery depending on their vulnerabilities, capacities, and resiliencies. This study aims to identify latent mental and physical health trajectories and their associations with person- and place-based pre-disaster predictors. Using an Australian, population-based, longitudinal dataset spanning 2009-19, group-based multi-trajectory modelling was applied to identify the distinct mental, social, emotional, and physical health trajectories of people who had experienced damage to their home following a climate-related disaster event. Multinomial logistic regression was used to assess a series of social vulnerability predictors (demographic, socioeconomic, housing, health, neighbourhood, and geographical) of health patterns. We identified three distinct health trajectories. Most individuals experienced small or minimal health impacts at the time of the disaster year followed by a fast recovery. However, one-fifth of the exposed population were severely affected during and post disaster. This cohort had the worst mental and physical health prior to the disaster and experienced the largest decreases in mental and physical health and the lowest recoveries. Pre-existing mental and physical conditions were the most substantial risk factors, increasing the probability of experiencing high impact and slow recovery by 61% for mental health and 51% for physical health. In addition, vulnerability in the form of housing affordability stress, lower household income, and lack of community attachment, participation and safety were also significant independent risk factors for ongoing post-disaster health problems. Critically, people's mental and physical health recovery is dependent on pre-disaster vulnerabilities in health, resource access, and capacities. These findings could assist policymakers and health practitioners to more effectively target people most at risk and design prevention and response strategies to prevent the exacerbation of poor health and wellbeing.