Jingyi Zhao,1,2,* Xiaowei Hao,1,2,* Xiaofeng Sun,1,2,* Yajie Du,1,2 Meng Zhang,1,2 Qing Wang1– 3 

1Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, People’s Republic of China; 2National Institute of Health Data Science of China, Shandong University, Jinan, People’s Republic of China; 3Yellow River National Strategic Research Institute, Shandong University, Jinan, Shandong, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Qing Wang, Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China, Email wangqing1984@126.com

Introduction: This study includes health system capacities into the assessment framework of a temperature-resilience health system while accounting for system interactions.
Methods: In accordance with the guidelines provided by the World Health Organization, the conceptual framework of a climate-resilient health system has been adopted. The International Health Regulations are utilized to assess the health system capacities in 171 countries from year 2011 to 2019. Exploratory factor analysis and reliability tests have been conducted to confirm the validity and reliability of the framework. Moreover, a data-driven decision-making trial and evaluation laboratory method is employed to quantify the interactions among the structured aspects.
Results: The assessment framework consists of five aspects, namely high temperature-sensitive risks, low temperature-sensitive risks, low-temperature exposure, vulnerability factors and health system capacities. Globally, the mean (standard deviation) for addressing the first four aspects are 0.77 (0.14), 0.87 (0.13), 0.88 (0.21), 0.72 (0.17), respectively, and health system capacities reach 0.67 (0.17). This study identifies health system capacities as the main driving forces. Interactions between it and other aspects call for multisectoral and coordinated actions. On a global scope, low-temperature exposure and its health risks, with the strongest dependence, should be prioritized to enhance temperature resilience, especially in high-income countries. In order to mitigate these risks, it might be necessary to disrupt the cascade effects resulting from low-temperature exposure by leveraging the capacities of coordination and multisectoral communication. Notably, low-income countries are more affected by high-temperature exposure, thus requiring flexible ways to strengthen temperature resilience.
Discussion: Our study underscores the significance of health system capacities in strengthening a temperature-resilient health system. Undoubtedly, the development of the temperature-resilient health system ought to follow a coordinated and flexible approach, giving priority to dealing with low-temperature exposure.

Keywords: temperature resilient, health system capacities, interactions, decision making trial and evaluation laboratory method