Climate change adaptation responses are being developed and delivered in many parts of the world in the absence of detailed knowledge of their effects on public health. Here we present the results of a systematic review of peer-reviewed literature reporting the effects on health of climate change adaptation responses in low- and middle-income countries (LMICs). The review used the ‘Global Adaptation Mapping Initiative’ database (comprising 1682 publications related to climate change adaptation responses) that was constructed through systematic literature searches in Scopus, Web of Science and Google Scholar (2013–2020). For this study, further screening was performed to identify studies from LMICs reporting the effects on human health of climate change adaptation responses. Studies were categorised by study design and data were extracted on geographic region, population under investigation, type of adaptation response and reported health effects. The review identified 99 studies (1117 reported outcomes), reporting evidence from 66 LMICs. Only two studies were ex ante formal evaluations of climate change adaptation responses. Papers reported adaptation responses related to flooding, rainfall, drought and extreme heat, predominantly through behaviour change, and infrastructural and technological improvements. Reported (direct and intermediate) health outcomes included reduction in infectious disease incidence, improved access to water/sanitation and improved food security. All-cause mortality was rarely reported, and no papers were identified reporting on maternal and child health. Reported maladaptations were predominantly related to widening of inequalities and unforeseen co-harms. Reporting and publication-bias seems likely with only 3.5% of all 1117 health outcomes reported to be negative. Our review identified some evidence that climate change adaptation responses may have benefits for human health but the overall paucity of evidence is concerning and represents a major missed opportunity for learning. There is an urgent need for greater focus on the funding, design, evaluation and standardised reporting of the effects on health of climate change adaptation responses to enable evidence-based policy action.

An assessment of the global progress in climate change adaptation is urgently needed. Despite a rising awareness that adaptation should involve diverse societal actors and a shared sense of responsibility, little is known about the types of actors, such as state and non-state, and their roles in different types of adaptation responses as well as in different regions. Based on a large n-structured analysis of case studies, we show that, although individuals or households are the most prominent actors implementing adaptation, they are the least involved in institutional responses, particularly in the global south. Governments are most often involved in planning and civil society in coordinating responses. Adaptation of individuals or households is documented especially in rural areas, and governments in urban areas. Overall, understanding of institutional, multi-actor and transformational adaptation is still limited. These findings contribute to debates around ‘social contracts’ for adaptation, that is, an agreement on the distribution of roles and responsibilities, and inform future adaptation governance.

With economic growth and the improvement of the urbanization level, human activities have constantly interfered with landscape patterns, resulting in serious threats to regional ecological security. Therefore, it is of great significance to study the evolution and optimization of the landscape patterns. Based on three TM images from 1990, 2000, and 2010, and selected landscape pattern indexes, the changes in the landscape pattern of Nanjing in the past twenty years were studied based on landscape ecology theory using Remote Sensing (RS) and a Geographical Information System (GIS). The ecological network was built on the basis of extracted ecological nodes and the minimum cumulative resistance. The results show that changes in the landscape pattern of the city of Nanjing were notable. Class-level indexes indicate that the farmland landscape area decreased and the degree of patch fragmentation increased. The construction land area increased, and it tended to show dispersed distribution. The proportion of forest land increased and the shape of patches became more complex. The proportion of water firstly showed a decrease, followed by an increase, and the shape of the water became more regular. Landscape-level indexes indicate that biological diversity and the degree of fragmentation increased. Spatial heterogeneity of the natural landscape increased, and the patch shape of each landscape type developed similarly. The results also call for stepping-stones to enhance the connectivity and optimization of the ecological network, which will help improve ecological services and improve the landscape pattern of the city.