The impact of climate change on health needs structured evidence assessment and an evidence to action framework to make decisions: A proposal to adopt the GRADE approach

  • Ignacio Neumann
    School of Medicine, Universidad San Sebastián, Santiago, Chile

    Department of Health Research Methods, Evidence & Impact, McMaster University, Ontario, Canada

    GRADE Conosur, Universidad San Sebastián, Santiago, Chile
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  • Josep M. Antó
    ISGlobAL, Barcelona Institute for Global Health, Barcelona, Spain

    IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain

    Universitat Pompeu Fabra (UPF), Barcelona, Spain

    CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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  • Jean Bousquet
    Charité. Institute for Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

    Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany

    University Hospital Montpellier, France
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  • Holger J. Schünemann
    Correspondence to: Holger J. Schünemann, MD, PhD, Michael G. DeGroote Cochrane Canada and McGRADE Centres, Departments of Health Research Methods, Evidence and Impact and of Medicine, McMaster University Health Sciences Centre, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada, Tel: +1 905 525 9140 x 24931
    Department of Health Research Methods, Evidence & Impact, McMaster University, Ontario, Canada

    Department of Biomedical Sciences, Humanitas University, Milan, Italy

    Michael G. DeGroote Cochrane Canada Centre & McMaster GRADE Centre, McMaster University, Hamilton, ON, Canada
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      • The outcome of the COP26 suggests a striking lack of structured evidence assessment and decision-making processes in the existing literature on climate change. This lack of structure and process has major implications for policy making and it is of general and cross-disciplinary interest. Our review of systematic reviews in climate change has revealed that authors are unaware of structured approaches to assessing the certainty of a body of evidence and there is no structured way employed for making decisions.
      • This article describes a proposal focused on using the GRADE approach for this type of evidence and related decision-making. The GRADE approach has been used successfully in 1,000’s of public health, clinical and policy recommendations. It is currently the standard for many health organizations around the world, including the World Health Organization.
      • In brief, GRADE is a structured and transparent way to summarize the available evidence, rate its certainty and move from evidence to action. We believe that our proposal to adopt GRADE has the potential for important impact on this critical field of research and evidence-informed decision making.



      To highlight how using the GRADE approach to understand the certainty in the evidence about the impact of climate change in health outcomes increases transparency. Also, how GRADE can enhance communication and decisions about adaptation and mitigation strategies.

      Study Design

      We developed a narrative review based on an assessment of exiting systematic reviews adressing the effect of climate change on health outcomes and the impact of mitigation and adaptation strategies.


      Adopting structured approaches such as GRADE to tackle the impact of climate change on health may help to: 1. Define the specific question to be addressed; 2. Summarize the evidence in a structured way and assess uncertainty; 3. Provide a systematic framework to move from evidence to action and to offer recommendations of different strength; 4. Provide a systematic way to adapt recommendations to specific settings; and 5. Provide a framework to assess the certainty of modeled evidence.


      In this article, we describe epidemiologic principles that could be utilized to move decision making in climate change forward.


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