Public health adaptation to climate change in the federalist states of Canada and Germany

Climate change is projected to have considerable impacts on human health, and public health institutions at all levels of government will need to adapt to protect the health of populations. The impacts of climate change are highly localized, thus federal systems are expected to have the inherent advantage of allowing for regional diversity and policy experimentation in adaptation, but are also prone to conflict and stalemates. In addition, local public health authorities often lack the capacity to adapt to climate change, despite being on the 'front lines' of climate impacts. Assistance is needed from upper-level governments for local-level public health adaptation to climate change. It is unclear, however, how different levels of government are interacting for public health adaptation or what form that support should take beyond vague calls to build capacity. This thesis examines the relationship between different levels of government in Canada and Germany for public health adaptation, framed in federalism, intergovernmental relations, and adaptive capacity concepts. This thesis aims to i) characterize how intergovernmental dynamics are patterned across national, regional, and local levels of government in federal systems for public health adaptation to climate change; and ii) examine how federal and regional governments could contribute to enabling and supporting local public health authorities' adaptive capacity in federal systems. This research is based on 28 semi-structured interviews in comparative nested case studies of Quebec, Canada and Baden-Württemberg, Germany. I find that coordination between levels of government specifically for climate change and health is rare, but climate change issues are occasionally discussed through existing methods of public health coordination. Interactions for public health adaptation between the federal and regional governments follow expected patterns of intergovernmental relations (i.e., loosely coupled in Canada, tightly coupled in Germany), but I find the inverse occurring in the relationship between regional governments and local public health authorities in each country. Additionally, adaptive capacity varies widely between local public health authorities, but all report having insufficient funding, and consequently staff, for adaptation activities. Based on interviewees' perspectives and needs, and complemented by adaptation literature, I identify specific measures upper-level governments can take to build local public health authorities' capacity for adaptation, grouped under the action-oriented and interrelated themes of: building financial capacity; fostering knowledge, knowledge translation and skills; collaborating and coordinating for shared knowledge; and claiming leadership. These findings contribute to adaptation literature by demonstrating how adaptation is occurring across multiple levels of government in the public health sector and characterizing approaches to in coordination and interactions in the two case studies. Moreover, this research supports decision-makers seeking to enable sub-national public health adaptation to climate change.

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