Integrating equity in climate change adaptation processes using health promotion principles: Extreme heat events and ambrosia (ragweed) pollen allergic symptoms as case studies

Background: Climate change (CC) is associated with social inequities in health. CC adaptation processes frameworks represent the total stages and processes aiming to develop and improve adaptation strategies to climate change's impacts across time. They include six main stages: awareness to adapt, resource mobilisation, adaptive capacity, implementation of adaptation actions, evaluation and adjustment. Such frameworks can be applied in public health. However, none has yet considered equity as a central aspect of developing adaptation strategies. Objective: We propose a framework to guide the development and implementation of equity-oriented adaptation processes strategies. We apply this framework to two response plans elaborated in Montreal, Canada: with heat waves and with Ambrosia pollen allergic symptoms. Methods: Using an adaptation processes strategy, a framework has been developed which integrates equity considerations at each of the six stages in the CC adaptation process. We applied this framework to two case studies to illustrate how it can formalize equity considerations at each stage. Results: Our framework builds on principles of equity and participation, and integrates the five action pillars of the Ottawa Charter for Health Promotion. We found that equity could be integrated at each of the six stages. In the Montreal response plans, integrating community-based actors at each stage, using socio-economic data in evaluation processes, and implementing adaptation measures considering heat islands intra-urban spatial disparities could be relevant strategies. Conclusion: Equity-focused adaptation processes strategies have the potential to reduce social inequities in health derived from CC manifestations, and reinforce populations' future adaptation capacities.