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Abstract

This doctoral thesis critically investigates the integration of health into climate adaptation policy and practice within the Canadian context. Through four empirical chapters, three of which have a particular focus on municipalities in British Columbia, it explores how health is understood, planned for, and acted upon in relation to climate change. This work is grounded in an analysis of interviews, planning documents, survey data, and a regional case study. Chapter 2 presents qualitative findings from interviews with local government leaders, examining their perceptions of climate-related health risks and their experiences with adaptation. It highlights governance gaps and calls for more multi-sectoral collaboration. Chapter 3 analyzes municipal climate action plans across British Columbia to assess how health is incorporated. While health risks are often acknowledged, the study finds limited integration of health systems or consideration of health co-benefits. The chapter recommends advancing a “Health in All Climate Policies” approach to strengthen cross-sector collaboration and public health responsiveness. In Chapter 4, survey data reveal that 23% of Canadians report experiencing physical health impacts from extreme weather events. Additionally, the survey shows that attitudes towards adaptation are influenced by a complex interplay of risk perception, health awareness, community belonging and demographic characteristics. The final chapter, Chapter 5, examines the implementation of cooling and cleaner air shelters in Metro Vancouver. Drawing on interviews with public and non-profit professionals, it identifies key lessons on service design, access, and the importance of sustained collaboration across sectors to protect vulnerable populations during extreme heat and wildfire smoke events. Overall, this thesis argues for stronger integration of health into climate policies and greater collaboration between health systems, local governments, and communities to protect public health in a rapidly changing climate.