Climate Change and Human Health in the Arctic: A Review

: Over recent decades, the Arctic has begun facing a range of climate-related challenges, from rising temperatures to melting ice caps and permafrost thaw, with significant implications for ecosystems and human well-being. Addressing the health impacts of these issues requires a comprehensive approach, integrating scientific research, community engagement, and policy interventions. This study conducts a literature review to assess the effects of climate change on human health in northern latitudes and to compile adaptation strategies from the Arctic countries. A literature search was performed between January and April 2024 for papers published after 2000, using the electronic databases Web of Science, Pubmed, Science Direct, Scopus, Google Scholar, and eLibrary.RU, with specific questions formulated to direct the search: (i) What are the climate changes? (ii) How does climate change affect human health? (iii) What adaptation measures and policies are required? The key phrases “climate change”, “human health”, “adaptation practices”, and “Arctic” were employed for searching. Ultimately, 56 relevant studies were identified, reviewing health risks such as infectious diseases, mental health issues, and diseases connected with extreme weather events; wildfires and their associated pollution; permafrost degradation; pure water; and food quality. The paper also examines mitigation and adaptation strategies at all levels of governance, emphasizing the need for international cooperation and policy action to combat negative health outcomes, investments in healthcare infrastructure, emergency preparedness, and public health education. Incorporating diverse perspectives, including Indigenous knowledge, Community-Based Adaptation, EcoHealth and One Health approaches, is crucial for effectively addressing the health risks associated with climate change. In conclusion, the paper proposes adaptation strategies to mitigate the health impacts of climate change in the Arctic.


Introduction
Modern climate change represents one of the most pressing challenges of our time, with far-reaching impacts on ecosystems, economies, and societies worldwide [1,2].Global climate change and its impacts on the Arctic region have become increasingly significant topics of concern in recent years.The Arctic is experiencing a rate of warming nearly two to four times faster than that of any other area on the planet; this phenomenon, known as Arctic amplification, is a key aspect of contemporary climate change [3][4][5][6][7][8][9].
The multifaceted effect of climate change in the Arctic includes rising temperatures, melting ice caps and sea ice, permafrost thaw, shifting ecosystems, and socioeconomic implications, including human health and well-being [3,5,[10][11][12].The loss of sea ice and ecosystem rearrangement in northern marine Alaska, extreme heatwaves in western Canada, and the decline of snow cover in Greenland are novel and combined extreme events, reported nearly daily, elevating the urgency surrounding climate change to a new, heightened level, with the term "super climate extremes" employed to describe this phenomenon [13].In the summer of 2016, the high-latitude Arctic was blistered with extended periods of record-breaking heat.Surface temperatures during October-December Climate 2024, 12, 89 2 of 35 were, on average, nearly 5 • C above those expected in an area spanning the Arctic Ocean, from Greenland across the North Pole to far eastern Russia.Even more astounding were the daily anomalies, which exceeded +16 • C in many locations [14].In 2020, Northern Siberia experienced a heat wave characterized by exceptionally high monthly temperatures, with the highest absolute record of 38 • C in a Siberian town north of the Arctic Circle [15], and with anomalies reaching up to +6 • C [16].
Fueled by polar amplification, the warming of the Arctic serves as compelling evidence of global climate change.The altered seasonal temperature signal significantly influences the timing of exceptionally cold and warm monthly periods: the reduction in seasonal temperature fluctuations is expected to further intensify as sea ice continues to diminish and upper-ocean warming persists, and consequently, the rate of change in extreme cold temperatures during Arctic winters may outpace that of extreme warm temperatures during summers as the Arctic continues to warm [9,17].Observations show consistent warming and fewer incidents of extreme cold in the Arctic, with a notable decrease in cold days and nights, frost days, and ice days over the past two decades [18].Widespread cold spells in both the winter and summer have significantly decreased throughout the Arctic [19].A reduction in the duration of the cold season in northern Fennoscandia indicates a notable decrease in extremely cold weather occurrences across all seasons, along with increases in extremely warm weather events, especially during the spring and autumn seasons [20].The weather patterns in the Arctic are characterized by high and increasing variability [10].Since 2002, the likelihood of encountering heat waves in the Arctic has become comparable to or even greater than that in the middle and low latitudes: a rise in the frequency of heat waves across the terrestrial Arctic is particularly noticeable in the Canadian Arctic Archipelago and Greenland [21].Extreme events have intensified in Alaska [22], and Alaska's climatic shifts demonstrate approximately 50% more warming compared to air temperature trends in the contiguous United States [23].Alaska's Beaufort Sea has witnessed a significant sea ice decline, leading to milder winters, but heightened heat wave risks in continental high latitudes due to ongoing ice melt [24].It is supposed that in the future, the ongoing Arctic warming will exacerbate systemic effects and present significant challenges for northern communities, including continued temperature and precipitation increases, amplified permafrost thaw due to changes in seasonal snow cover and land ice, virtually certain glacier ice loss, and heightened coastal impacts from rising sea levels and extreme volatility [25].
Extreme climate events are currently intensifying in the face of climate change, threatening human health, economies, and environments, with ongoing global warming expected to increase the frequency and severity of these hazards, further intensified by factors like population growth, urban development, and aging infrastructure, particularly impacting vulnerable demographics such as the elderly, children, and those with certain health conditions, with rural areas facing heightened vulnerability [1][2][3][26][27][28].Consequently, heat waves in the Arctic are increasingly posing threats to local vegetation, ecosystems, human health, and the economy [21].
Climate change results in alterations to the Arctic landscape, primarily driven by the degradation of permafrost, which leads to significant shifts in phenomena such as mudflows, cryogenic landslides, abrasion, erosion, suffusion, frost heave, solifluction, thermokarst, among others; in certain instances, the intensity and extent of these processes escalate, with heaving processes and thermokarst expected to become notably more active by the year 2050 [29,30].Approximately four million people and 70% of existing infrastructure in permafrost regions face a high risk of near-surface permafrost thaw, jeopardizing the sustainable utilization of natural resources and the development of Arctic communities; findings reveal that one-third of pan-Arctic infrastructure and 45% of hydrocarbon extraction fields in the Russian Arctic are located in areas where thaw-induced ground instability could cause severe damage to built structures [31].The thawing of permafrost poses a risk of releasing biological and chemical materials that have been stored for tens to hundreds of years [32].Upon re-entering the environment, these substances could potentially disrupt Climate 2024, 12, 89 3 of 35 ecosystem functions, diminish populations of distinctive Arctic wildlife, and pose threats to human health [33].
As a result of climatic warming, large fires in the Arctic are anticipated to become more frequent before the middle of the century due to the temperature trend approaching a critical threshold, where even slight temperature rises are linked to exponential increases in the burned area [34]. A. Descals et al. mentioned that Arctic fires can release significant amounts of carbon from permafrost peatlands [34].Satellite observations indicate that in 2019 and 2020, fires burned approximately 4.7 million ha, which represents 44% of the total burned area in the Siberian Arctic from 1982 to 2020 [34].C. Gibson et al. demonstrate that wildfires have directly caused the development of 2200 ± 1500 km 2 (95% CI) of thermokarst bogs in Canadian permafrost peatlands over the past 30 years, accounting for approximately 25% of all thermokarst bog expansion during this period [35].Wildfires in the Arctic release significant quantities of black carbon and other aerosols, particulate matter, carbon monoxide, and other harmful pollutants into the atmosphere, accelerating Arctic warming, amplifying the effects of climate change and altering regional weather patterns, additionally leading to degraded air quality and respiratory health hazards for nearby communities [34].Direct effects of wildfires on human health and well-being include exposure to heat flux, resulting in injuries and destructive outcomes; indirect impacts stem from emissions, leading to health issues related to smoke exposure, and alterations in ecosystem functioning, affecting biodiversity, amenities, water quality, and thawing permafrost [35][36][37].
Over half of known human pathogenic diseases can be aggravated by climate change [38].The Arctic's rising temperatures may lead to the liberation of pathogenic microorganisms trapped for ages within frozen layers, as permafrost and glaciers thaw [32,39].Global pollution and communicable diseases are shown to pose threats to Indigenous peoples living in the Arctic and sub-Arctic regions.These threats are likely to be greater than those faced by populations living elsewhere in the world [40].More than 50 million individuals in the Arctic lack access to safely managed drinking water services, with a notable impact on remote northern communities, where a significant proportion of Indigenous peoples reside.Recent studies have highlighted issues such as poor water quality and inadequate water supply within Indigenous communities [41].
As climate is changing faster in the Arctic than anywhere else on the planet, there is an urgent need to address the issue: alterations in sea ice, snow cover, lake and river ice, and permafrost impact various facets of the economy, infrastructure, health, livelihoods, culture, and identity of both Indigenous and non-Indigenous communities.Moreover, in the coming decades, additional extreme events are anticipated in the Arctic, with their environmental and societal ramifications extending beyond the region and affecting areas beyond its borders [42].
Addressing the health impacts of climate change in the Arctic requires holistic and interdisciplinary approaches that integrate scientific research, community engagement, and policy intervention.At the same time, these approaches should promote the idea that humans and other animals share the same planet and face the same environmental challenges, infections, and health issues, with One Health and EcoHealth being two of the most influential concepts among these approaches.The One Health approach in the Arctic focuses on the interconnected health of humans, animals, and the environment within this unique and vulnerable region.It emphasizes the collaboration among various disciplines, including public health, veterinary medicine, and environmental science, to address health challenges exacerbated by climate change, such as the spread of infectious diseases, food security, and the health of indigenous communities and wildlife [43].The EcoHealth approach in the Arctic prioritizes the health and well-being of the fragile northern ecosystems, recognizing the intricate relationships between humans, animals, and the environment.It places a strong emphasis on biodiversity and the impacts of environmental changes on all living organisms, involving multidisciplinary efforts to understand and mitigate the effects of climate change, pollution, and other stressors on the Arctic's vulnerable ecosystems and the health of its inhabitants [44].
Strategies for adaptation and resilience-building should also prioritize Indigenous knowledge systems, incorporate local perspectives, and foster collaboration between all stakeholders.Despite the extensive scientific discussion, there have been limited studies integrating research from the Arctic countries and focusing on actual adaptation efforts across various decision-making levels.Thus, in this study, an attempt is made not to encompass all related literature, but rather to seek to address the gap by conducting a literature review.The paper endeavors to assess the impact of climate change on human health in the northern latitudes and to compile proposed adaptation strategies from the Arctic countries to mitigate these effects.It was executed in three phases: (i) identifying climate change challenges in the Arctic and its regions; (ii) assessing climate change impact on human health in its different aspects; and (iii) recognizing adaptation strategies within the health sector.We anticipate our findings will not only guide future research on effective health system adaptation strategies across diverse countries in the northern regions, but also illuminate the factors influencing and hindering climate change adaptation in the healthcare system in the Arctic.
The remainder of the paper follows this structure: Section 2 outlines the Materials and Methods used in this study.Section 3 presents the Results, detailing the findings of this study; this section is divided into three main Sections: Section 3.1.Climate change risks for human health, Section 3.2 Specific consequences of climate change and human health, and Section 3.3 Adaptation strategies, including a summary table with outputs from all selected papers.Section 4, the Discussion, delves into additional aspects and presents concluding comments, such as adaptation strategies to heat and cold (Section 4.1); adaptation efforts in regards to wildfires and their consequences to mental health (Section 4.2) and infectious diseases (Section 4.3); considerations of EcoHealth, and One-Health perspectives (Section 4.4); and the incorporation of Indigenous knowledge and community efforts in the adaptation process (Section 4.5).Section 5 discusses different levels of adaptation efforts, from local to regional, national, and international.Section 6 provides a look at opportunities for the adaptation process and the challenges of maladaptation.Finally, Section 7 offers the main conclusion as a list of strategies for societal adaptation to the effects of climate change on human health in the Arctic.

Materials and Methods
A literature search was conducted from January to April 2024 using the electronic databases Web of Science, Pubmed, Science Direct, Scopus, and Google Scholar, focusing on peer-reviewed journal articles published after 2000 in English, with abstracts and full texts available.We also searched in the scientific electronic library eLibrary.RU, a prominent Russian information portal covering science, technology, medicine, and education, for articles with abstracts available in English.Prior to the review process, specific questions were formulated and utilized to guide the literature review: (i) What are the current and projected climate changes?(ii) How does climate change impact human health, both currently and in the future?(iii) What adaptation measures and policies are necessary?
The key phrases and keywords "climate change", "human health", "adaptation practices", "adaptation actions", and "Arctic" were used.Additionally, reference lists from identified papers were examined.
The summarizing nature of this review is aimed at achieving breadth rather than exhaustive coverage, encompassing various climate change challenges and their health outcomes across countries in the northern latitudes.The initial focus was on selecting the first pertinent studies published after 2000.Inclusion criteria required publications to address climate change impacts on the health status of the population and adaptation strategies in Arctic countries with cold climates, without bias in selection.Ultimately, 56 studies meeting these criteria were identified, without restrictions on study design.
It is crucial to know that challenges related to climate change and adaptation measures are influenced not only by climatic factors, but also by social and economic variables.This review refrains from categorizing findings based on specific assumptions and instead seeks to elucidate and consolidate relevant challenges and opportunities, considering multiple factors associated with climate change.However, the findings presented herein can be utilized alongside identified prerequisites to evaluate the suitability of specific tasks or opportunities within a particular context.

Climate Change and Multiple Risks for Human Health
Due to the complex and interconnected nature of climate change consequences, which can sometimes have cascading effects, it is challenging to separate them and their associated health outcomes.Hence, authors often address them within a single research agenda to provide a comprehensive understanding of the issues [44,46,49,50].As an example, M. Brubaker et al. [45] demonstrated the multifaceted impacts of climate change as heightening vulnerability to injury, disease, mental stress, and food and water insecurity [43].The primary effects of climate change on human health in Arctic regions include (i) an increasing rate of morbidity and mortality due to extreme temperatures [44,50]; (ii) changes in thermal comfort as a whole [50]; (iii) exacerbated vulnerability to conditions such as skin cancers, burns, infections, eye ailments, and weakened immune function [45,46].Additionally, there is (iv) an increase in mental stress and psychological strains [43][44][45].Individuals face (v) heightened exposure to environmental toxins, leading to health issues [46,49]; (vi) elevated risk of vector-borne diseases [46]; (vii) challenges related to food and water insecurity [44,45,49,50].Moreover, there is (viii) a rise in accidents during subsistence activities like hunting and harvesting, as well as while traveling [43,46,48].Climate change impacts various demographic groups, including those with climate-sensitive ailments like respiratory and cardiovascular disease [46], as well as different age groups, such as young people [47].
Furthermore, climate change, including phenomena like permafrost thawing, coastal erosion, sea level rise, and alterations in forest fire risks, pose threats to the infrastructure, built environment [48][49][50], and medical care system, which is particularly critical in the remote Arctic communities, where access to health services and delivery is paramount [44].

Climate Change and Infectious Disease
Infections are a common challenge in all Arctic countries.Climate change influences their prevalence, distribution, and transmission dynamics in the Arctic: studies demonstrate its effect on different aspects of infectious diseases in the whole Arctic or several of its regions [59][60][61]64], in Scandinavia, particularly Sweden and Finland [52,53], in Alaska (USA) [55,56], in the northern parts of Canada [54,57,62], and in Russia [58,63].Rising temperatures are expanding the geographical range and northern spread of common foodborne pathogens, water-borne illnesses, and zoonotic infections, including vector-borne diseases like West Nile virus, as well as the introduction of new viral pathogens, as shown for the Arctic communities in Sweden and Finland [53], in Alaska [55], in Canada [57,62], and in Russia [63,64], and for the whole Arctic [59][60][61].In 2014, an intense heat wave led to historically high sea surface temperatures, causing Vibrio bacteria to appear in northern Scandinavia at latitudes where they were previously not found or rare [52].Thawing permafrost and changing precipitation patterns may facilitate the release of dormant pathogens.Unusually warm temperatures in the summer of 2016 resulted in rapid permafrost degradation and an anthrax outbreak near the Russian city of Salekhard, leading to tragedy [58,64].It was reported that a 12-year-old boy died, five adults and two additional children were confirmed to have contracted the disease, at least 63 individuals were evacuated, and 2300 reindeer perished [58].
Climate change can exacerbate wastewater management challenges, posing additional health risks.Exposure to microbial hazards in wastewater has been linked to acute gastrointestinal illness and other severe health issues, as observed in northern Canadian communities [54] and in Alaska [56].For instance, many isolated Alaskan communities are particularly vulnerable to infectious disease transmission due to inadequate water and sanitation infrastructure [56].
Table 1 below provides more details regarding the main pathogens and their related health consequences in the northern regions.Researchers demonstrate that the cold climates of the circumpolar north impose restrictions on mobility and disrupt livelihoods.The effects of these issues on mental health are heightened by changes in culture and identity, worries about food security, interpersonal tensions, conflicts, and housing challenges [65].Community-specific analyses in the Canadian Arctic regions revealed that each community exhibited unique associations between meteorological conditions and the incidence rate of daily mental health-related visits [66,67].Changes in weather patterns, snow and ice stability, and shifts in wildlife and vegetation distribution due to climate change have negative effects on mental health and well-being.These changes can lead to increased family tensions, higher indicence of substance abuse, exacerbation of existing injuries and mental health issues, and an elevated risk of suicidal thoughts [66][67][68].

Climate Change and Extreme Temperatures
A significant portion of the research focuses on the impact of extreme temperatures on human health in the Arctic, encompassing not only heatwaves and cold spells, but also generally extremely cold weather, found in the regions of Finland [72,77,78], Alaska in the USA [71], the cities of the Russian North [73][74][75][76]79], and vast areas including several other countries [80].The estimations of extremes are determined based either solely on air temperature (Ta) [72][73][74][75][76][77][78][79][80], or using thermal indices like the Heat Index (HI) [71], Wind Chill Index [75], or the Universal Thermal Climate Index [70].These indices not only consider air temperature, but also incorporate factors such as wind, humidity, and solar radiation, as well as physiological and behavioral variables like activity levels, clothing, posture, and underlying physical condition [100].
Extremely hot weather and heat waves are linked with the increased risk of heat illness and cardio-respiratory health effects [71,78,79].It is also noted that extremely hot and extremely cold weather, including both heat waves and cold spells, result in additional deaths, with an increased risk of total and cardiovascular mortality [73][74][75][76]79], with the elderly and children being the most climate-vulnerable population groups [69,71,[78][79][80].Some positive consequences of hot weather are also marked, such as the reduced cumulative risk of sick leave taken during heatwaves [72] and the reduced risk of overall respiratory and arrhythmia admissions, as well as asthma attacks [78], in Finland.
Despite the substantial reduction of cold exposure in the past few decades, weather in the Arctic remains extremely cold, particularly in Alaska [70].Cold weather poses risks of stillbirth [69], along with an increase in the number of out-of-hospital cardiac arrests [77].

Climate Change, Wildfires, and Associated Pollution
The impact of wildfire activity on human health in the Arctic is evident for both Alaska, USA [81,82], and the Republic of Sakha (Yakutia), Russia [83,84].In Alaska, wildfires result in a significant number of rural communities experiencing several days each year with air quality rated as "unhealthy" or worse [81], leading to immediate and long-term mental health issues [82].The combination of wildfires and increased air pollution exacerbates respiratory diseases and leads to eye complications [84], further aggravating human health and the ability to pursue livelihoods [83], as observed in Sakha (Yakutia).Given the remote locations of many Arctic communities, with limited infrastructure and considerable distances from medical facilities, residents may encounter difficulties accessing essential health services during and after wildfire events [81].

Climate Change and Permafrost Degradation
Human well-being and the health consequences of permafrost degradation have been studied for remote communities in the northern regions of Canada [88], Russia [85][86][87]89], and the USA [89].Thawing permafrost has wide-ranging effects on the economy and infrastructure, directly and indirectly affecting human health and livelihoods.For instance, it can lead to the spread of infectious diseases and the seepage of toxic waste into rivers and groundwater [86,87]; it can damage road infrastructure and ruin buildings, restricting access to health facilities [86][87][88].Additionally, thawing permafrost changes thermal conditions around ice cellars [85,89], worsening the overall living conditions of Indigenous and non-indigenous communities [86,88].

Climate Change, Water and Food Security
Shifts in environmental conditions caused by climate change can alter the dynamics of food and water-borne illnesses, with implications for food security and safety in Arctic communities: changes in ice cover and sea surface temperatures are impacting marine ecosystems and the availability of traditional food sources, potentially affecting the nutritional status and susceptibility to infectious diseases among Indigenous populations, which is observed for the northern areas of Canada [94,95,97,99], Russia [90,91,93], and the USA (Alaska) [92,98].The reduction of access to traditional food resources, along with a decline in their availability and quality [90,92,94,99], as well as a decrease in the access to good-quality drinking water [91,[95][96][97][98], can have a crucial impact on the nutritional status of Indigenous populations.The consequences of climate change not only diminish the availability and distribution of subsistence resources, but also alter access for harvesters, resulting in resource shortages [92].
The findings in Ref. [90] revealed a significant decline of nearly 50% in the consumption of reindeer products among both Indigenous and non-Indigenous peoples in the Yamal-Nenets Autonomous District in Russia: only one-third of the population consumes venison once or twice daily.This shift poses a threat to their health because a diet rich in venison has been associated with several health benefits, including the promotion of antiatherogenic blood lipid fractions, maintenance of normal body weight, improvement of microcirculation and tissue fluid exchange, and enhancement of antioxidant protection against free radicals [90].Consuming river water poses significant health risks due to its contamination with heavy metals such as lead, cadmium, manganese, and iron; similarly, the consumption of meltwater from lake ice may impact health due to its low concentrations of beneficial ions [91].Decreased consumption of traditional foods by residents in Canadian Indigenous communities results in a lower intake of iron, zinc, protein, vitamin D, and omega-3 fatty acids [99], deteriorating the health status of the Indigenous populations.These effects negatively impact the capacity of individuals to adapt to cold stress and geomagnetic activity in the Arctic [90].

Adaptation Strategies
Tackling the intricate relationship between meteorology, climate change, and human well-being in the Arctic necessitates holistic approaches that prioritize adaptation, resilience, and mitigation measures.
Despite the diverse challenges and health impacts of climate change, these efforts underscore the importance of taking consistent steps towards adaptation.This includes bolstering institutional initiatives, such as strengthening the healthcare infrastructure to ensure resilience in the face of climate-related health risks [44,50,56,82,87,93,96].These strategies involve the implementation of comprehensive early warning systems for extreme weather events, air and ground pollution, and floods, enabling a timely response, as well and mitigation efforts, regarding these events, [49,50,57,70,71,73,74,77,78].Additionally, these strategies call for the establishment of robust environmental monitoring mechanisms to track and address environmental changes effectively [45,46,57,60,61,64,65,87,91,93,96,97,99].
Numerous papers highlight the profound and diverse impact that weather, whether immediate or delayed, exerts on shaping the overall health status, exacerbating or influencing specific disease [45,57,64,66,67,69,71,72,[76][77][78][79].These findings underscore the intricate relationship between climate and human health, thereby illuminating various pathways for the development of climate adaptation policies and programs.As an example, J. Middleton et al. emphasizes the necessity for culturally tailored and locally grounded research to adequately address the mental health consequences of climate change [66].
Moreover, this relationship necessitates the development of educational programs that not only integrate Indigenous wisdom, but also empower communities with the knowledge and tools to adapt to shifting environmental conditions [70,71,84,91,96,98].This includes advocating for traditional sustainable land management practices that have proven effective in mitigating climate impacts and preserving ecosystems [46,47,50].Furthermore, this strategy emphasizes fostering collaboration with Indigenous communities to leverage their invaluable traditional knowledge alongside scientific insights, promoting a synergistic approach to addressing climate challenges [45,60,65,70,88,89,99].Additionally, it underscores the importance of international cooperation in collectively confronting climate change [53], facilitated by effective financial support from authorities at various levels to enable impactful action on a global scale [56,83,86].
Community-Based Adaptation approach in the Arctic empowers local communities to address climate change impacts by integrating traditional and Western knowledge, actively involving community members in decision making, and recognizing their unique needs and circumstances [94].Adaptation policies, programs, and interventions should integrate EcoHealth principles, including systems thinking, interdisciplinary collaboration, community engagement, social and gender inclusivity, and the practical application of knowledge [44].The implementation of the One Health strategy will demonstrate effectiveness in identifying and addressing the impacts of climate warming at the community, ecosystem, and landscape levels [43,49,55,61,64,88].
Simultaneously, tailored adaptation measures are imperative, taking into account the varying climate change risks and their specific ramifications for human health.For instance, in regions experiencing permafrost thawing, upgrading water and sanitation systems, which may involve installing indoor plumbing infrastructure, emerges as a pragmatic solution to address challenges related to drinking water quality [56].Another illustrative example highlights the importance of proactive measures, such as establishing telephone hotlines or mobilizing volunteer networks to assist elderly residents during heat wave emergencies; these initiatives could not only enhance community resilience, but also mitigate the adverse health effects of extreme weather events, fostering a safer and more supportive environment for vulnerable populations [76].To enhance the drinking water infrastructure in Nunavik, Canada, in conjunction with traditional approaches, such as (1) implementing a robust environmental monitoring system and (2) educating the public about the dangers of consuming untreated water, D. Martin et al. suggested several specific actions, i.e., (3) upgrading wastewater disposal and municipal water systems, (4) engaging nursing staff in microbiological water testing at community locations, and (5) gathering pertinent health data during peak instances of gastrointestinal illness to explore potential links with water quality [97].
Climate change challenges illustrate various risks and specific concerns, such as infectious and mental diseases.Table 2 delineate health outcomes resulting from climate change consequences, encompassing extreme temperatures, wildfires and air pollution, permafrost thawing, and problems related to water and food security, along with adaptation strategies.In Table 2, for each subtopic, papers are organized in alphabetical order using the last name of the first author.
The characteristics of the studies included in the review were extracted, encompassing several key aspects.These include the primary climate change risks to human health as addressed in the study; the study area, including country, region, and specific city or community; the study population; the timeline, covered in each paper; study details such as author(s) and year of publication; manifestations of climate change observed and consequent impacts on human health; as well as adaptation strategies and actions proposed or already implemented in the studied regions.For some papers, additional notes may also be included.
Additionally, all aspects mentioned in Table 2 can be seen in the Figure 1.Reduction of traditional food access and availability, as well as quality of diet; nutritional implications of lower traditional food use include reductions in iron, zinc, protein, vitamin D, and omega-3 fatty acids Recognizing the connection between climate change and traditional food security based on regional and local data; monitoring at various levels; integration of scientific and traditional knowledge Additionally, all aspects mentioned in Table 2 can be seen in the Figure 1.

Discussion
The Arctic region, characterized by its extreme climate and unique ecosystems, is experiencing some of the most rapid and pronounced effects of global climate change.The anticipated outcomes of heightened Arctic warming include the continual depletion of both land and sea ice, posing risks to wildlife and traditional human ways of life, amplifying methane emissions, and potentially triggering extreme weather events at lower latitudes [4][5][6][7][8][9].These shifts are not only altering the physical landscape, but are also impacting the health and well-being of the Arctic inhabitants.In this context, the intersection of climate change and human health presents complex challenges and opportunities for public health intervention and adaptation strategies.
This paper offers a comprehensive overview of critical climate change indicators, comprising an increase in extreme temperatures, wildfires and the resultant air pollution, shifting patterns of permafrost, diminishing ice caps, and the resulting challenges related to water and food security.It evaluates the ramifications of these changes for human health, considering both direct and indirect impacts.Moreover, various socioeconomic, geographical, and infrastructural challenges prevalent in rural arctic areas are also explored, including remoteness, household overcrowding, the impacts of climate change, limited medical resources, and a high incidence of chronic illnesses [56].
Describing the health of modern circumpolar populations proves challenging due to significant regional disparities influenced by socioeconomic gaps among Indigenous and non-Indigenous communities, distinct population histories, lifestyle choices, environmental contamination, and inherent biological diversity.As shown by J. Josh Snodgrass [101], the overall health status in the Arctic varies greatly, ranging from excellent among the Sami populations in Sweden and Norway to extremely poor due to the living conditions experienced by marginalized indigenous communities in northern Russia.These circumpolar groups face ongoing threats from regional economic advancement and environmental pollution, alongside a distinctive vulnerability to the effects of global climate change [101].
The interventions for addressing climate change can be multiple and complex, presenting cascading hazards influenced by factors such as the age of infrastructure, maintenance challenges, and the cost of adaptation [33,102].
The paper examines mitigation and adaptation strategies aimed at addressing modern climate change, emphasizing the importance of international cooperation and policy action to limit negative health outcomes and build resilience to climate impacts.Investments in healthcare infrastructure, emergency preparedness, and public health education are essential for mitigating the health risks associated with different aspects of climate change such as temperature extremes, thawing permafrost, wildfires, and others.Mitigating the consequences of climate change demands significant financial and administrative resources.Predicting the extent and pace of future changes is challenging due to uncertainties and unresolved scientific issues, complicating estimates of the state and public's capacity to adapt to such changes [86].
Further considerations are addressed below, emphasizing additional aspects regarding the topic of human health adaptation to climate change.

Heat and Cold: Adaptation Strategies
Among the key environmental factors affected, temperatures and seasonality play crucial roles in shaping the health outcomes of Arctic communities.Many papers explore the complex interplay between extreme temperatures, seasonality, climate change, and their impacts on human health in the Arctic context.The findings can inform public health authorities for developing targeted interventions to mitigate excess mortality during cold spells and heat waves among vulnerable subarctic populations [76].To address the health ramifications of heat waves, cold spells, and climate change in the Arctic, comprehensive and adaptable approaches are essential.These encompass a range of strategies, including public health interventions, upgrades to infrastructure, community resilience enhancement, and policy initiatives informed by Indigenous knowledge and perspectives [45,61,70,86,[88][89][90][91].By prioritizing interdisciplinary research, fostering community involvement, and promoting collaborative efforts, it is possible to devise mitigation and adaptation measures that safeguard human health and bolster resilience against climate-induced temperature extremes in the Arctic [50,53,61,70].Further exploration of the intersection between climate change and health impacts on the vulnerable holds promise for providing valuable insights, empowering stakeholders to craft effective strategies aimed at mitigating the effects of heatwaves [26,27,71,74,76].Given the predicted future frequency of extreme heat events, the imperative to assess and plan for situations involving excessive heat, even in regions with historically mild climates, should not be underestimated [71].
Caution must be exercised to prevent overinterpretation, which can lead to inaccurate assessments and misguided public health policies.As an example, when talking about heat waves, we advise against extrapolating findings from extreme heat conditions to more typical summer ambient temperature ranges.Instead, following the suggestions of A. Bouchama et al., we advocate for an interdisciplinary approach that integrates physiological, clinical, and epidemiological perspectives, with a particular focus on understanding the role of behavioral thermoregulation and socioeconomic factors in linking normal ambient temperatures to mortality [103].Recommendations include analyzing excess mortality during specific heatwave periods and incorporating heat stress biomarkers to support causal claims for temperatures below heatwave thresholds.A careful and nuanced approach to interpreting associations between ambient temperature and mortality is essential for developing evidence-based public health policies.
Conversely, cold spells, marked by extremely cold temperatures and harsh weather conditions, remain a persistent threat to human health in the Arctic [17,70].Although the frequency of extreme cold events may decrease in the long term across the northern U.S., these cold extremes are not unprecedented, represent significant risks, and are likely to continue for several decades [96].Cold-related illnesses, including hypothermia, frostbite, and respiratory infectious diseases, are more common during periods of extreme cold, and are compounded by factors such as inadequate housing, limited access to heating, and outdoor exposure [104].However, it is worth noting that while cold weather plans typically focus on winter, this approach may overlook the need for measures to mitigate excess mortality/morbidity related to cold weather throughout the year [77].

Wildfires, Mental Health, and Adaptation Efforts
Outputs from wildfire adaptation efforts aim to mitigate the risk of wildfires and enhance wildland fire response.These outputs are enacted through legislative and regulatory mechanisms established at the regional level, in compliance with national mandates, and integrated into existing forest management policies [81,83,105].While there is evidence of wildfire adaptation planning in the Arctic, researchers indicate that the current nature and scope of these outputs are insufficient to effectively address the severity of climate change; significant deficiencies are identified concerning scientific research, human resources, and management approaches [105].To mitigate the adverse effects of wildfires on public health, it is essential to comprehend how human and environmental factors influence fire impacts, the understanding of which can inform targeted interventions at individual, community, and regional levels to minimize these effects [36].
With the growing occurrence of large wildfire events and other climate change-related disasters, it is imperative to prioritize the mental well-being of community members, as well as professional and volunteer service providers and responders, within adaptation and preparedness strategies.According to M. Hahn et al., key considerations should involve understanding the varied and extensive mental health responses that can emerge during and after wildfires, along with recognizing the unique characteristics of the local context and population that can affect the effectiveness and uptake of interventions [82].We contend that enhancing the prominence of climate change research in the Arctic and fostering improved dialogue among researchers, local Indigenous communities, and decision makers are essential steps.These measures are vital for generating actionable recommendations to policymakers, thus accelerating wildfire adaptation efforts in the Arctic.

Climate Change and Infectious Disease
Climate change impacts the transmission of infectious diseases in several ways.According to E. Finlayson-Trick et al. in their study for Canada, four key ways in which climate change impacts this transmission are highlighted, as follows: (1) it influences the development, reproduction, and mortality rates of microbes; (2) it affects the development, reproduction, and mortality rates of vectors and hosts; (3) it alters the behavior of hosts, microbes, and vectors; and (4) it changes host susceptibility [57].As the climate warms, the northward spread of infectious disease, the emergence of antibiotic resistance among bacterial pathogens, the resurgence of tuberculosis, the introduction of human immunodeficiency viruses into the Arctic communities, and the potential for pandemic influenza, or the sudden emergence of new viral pathogens present new challenges for residents, governments, and public health authorities across all Arctic nations [49,[52][53][54][55][56][57][58][59][60][61][62][63][64].Several additional notes are essential in this context.
First, the resurgence and dissemination of ancient diseases like anthrax stem from permafrost deterioration [49,58,64,86].This degradation raises concerns about the thawing of frozen carcasses containing infectious agents, leading to the potential spread of diseases.As Arctic temperatures rise, there is a risk of the release of pathogenic microorganisms trapped within the frozen strata of permafrost and glaciers.The melting of permafrost in cattle burial sites could lead to the reemergence of anthrax, posing a significant threat to northern areas [39].Over 200 burial grounds in Siberia contain anthrax-infected cattle, and thawing permafrost risks releasing pathogenic microorganisms trapped in the ice, potentially causing outbreaks [86].In summer 2016, a heat anomaly in Siberia led to a significant thaw, triggering the largest anthrax outbreak among reindeer herders near town Salekhard in the Arctic Circle.Anthrax, known as "Siberian plague", was last seen in the region in 1941; the outbreak hospitalized 72 herders, including 41 children, and killed over 2300 reindeer [58].Melting permafrost and potentially reviving anthrax highlight the urgency of establishing surveillance for emerging diseases in both wildlife and people [106].
Furthermore, navigating the confluence of climate change and the emergence of new diseases, such as COVID-19, in the Arctic presents a multifaceted challenge that intertwines environmental, health, and socioeconomic dimensions [56,107].Early responses to COVID-19 initially yielded low case numbers among Arctic Indigenous peoples, underlining valuable lessons for global regions.Yet persistent health gaps persist, notably in access to secure water and sanitation services, compounded by socioeconomic and infrastructure challenges [56,[106][107][108].The COVID-19 variability in the Arctic stems from factors like geographical isolation, effectiveness of prevention measures, healthcare systems, and vaccination rates, while lessons drawn from its spread, mortality, and morbidity, especially among Indigenous peoples, can guide responses to future pandemics, showcasing successful models characterized by proactive public health measures and vaccination campaigns, particularly in remote and marginalized communities worldwide [106,109,110].
Additionally, recognizing the influence of climate change on pathogen transmission, particularly concerning food and water sources, Arctic communities require assistance in formulating prevention and surveillance strategies tailored to their cultural context [57].As an example, reindeer products play a vital role in the local population's diet; preserving traditional dietary practices is essential, not only for health reasons, but also because these practices are deeply intertwined with Indigenous culture, contributing significantly to the overall health and well-being of Indigenous peoples.Upholding these nutritious customs also plays a crucial role in maintaining the cultural and environmental integrity of reindeer herding [90].
Moreover, biting insects, including mosquitoes, blackflies, and warble/botflies, have long exhibited a significant presence in the Arctic, and their response to climate change is notable [61,111].Changes in their populations can impact humans and wildlife alike, influencing disease transmission and disrupting culturally and economically significant activities [39,111].
As a whole, mitigating the threat of infectious disease outbreaks stemming from climate change necessitates a comprehensive approach; recommendations include bolstering public health systems, integrating disease surveillance with climate monitoring efforts; conducting research on the detection, prevention, control, and treatment of temperaturesensitive infectious diseases; cultural education based on traditional knowledge; and strategic planning [39,60,61].Enhancing diagnostic detection and raising clinical awareness of these emerging pathogens is essential for addressing the emergence of infectious disease in high-latitude regions [52].

EcoHealth and One Health Perspectives in the Arctic
Adaptation efforts should incorporate both EcoHealth principles, such as systems thinking and interdisciplinary collaboration, as well as the One Health strategy, effectively addressing CC impacts across communities, ecosystems, and landscapes [44,49,55,61,64,88,112]. Adopting an EcoHealth perspective suggests a need for bolstered, integrated, and communitydriven approaches to surveillance, warning systems, hazard epidemiology, support for traditional harvesters, co-management of wildlife resources, land-based skills training, enhancement of food systems, infrastructure safeguarding, and emergency management, among others, to address the impacts of climate change in the Arctic [44].To harness these advantages and effectively plan for climate change impacts, adaptation policies, programs, and interventions must be rooted in and incorporate EcoHealth principles such as systems thinking, transdisciplinarity, community involvement, social and gender equity, and the translation of knowledge into action [44].
The One Health paradigm, resonating strongly with Indigenous perspectives, acknowledges the interconnectedness of human, animal, and environmental health, offering proactive and collaborative strategies to address environmental risks and uncertainties, particularly in the rapidly changing Arctic, where it holds promise for enhancing resilience [43].
By integrating expertise from multiple disciplines such as medicine, veterinary science, ecology, and environmental science, the approach aims to address complex health challenges arising from climate change, biodiversity loss, and other environmental stressors.Through collaborative efforts, it seeks to promote sustainable development, preserve biodiversity, and safeguard the health and resilience of Arctic communities and ecosystems [49,55,61,64,88].Given the intricate and substantial impacts of climate change on Arctic ecosystems, as well as the close interconnections between their human and wildlife inhabitants, the Arctic region presents a fitting context for the development of the One Health approach.
Thus, both the One Health and EcoHealth approaches aim to identify and address the effects of climate warming at the community, ecosystem, and landscape scale [55].

Incorporating Indigenous Knowledge and Community-Based Adaptation
Indigenous peoples in the Arctic face heightened risks from global pollution and communicable diseases, surpassing those encountered by other populations worldwide.Given the accelerated pace of climate change in the Arctic, urgent action is imperative to address these challenges.Enhancing the understanding of the dynamic and evolving nature of inherited traditional knowledge in circumpolar human-environment interactions should be a primary focus of the research.This is particularly crucial, given the mounting pressures of accelerated climate change on Indigenous communities and the intricate socialecological systems they inhabit.Such efforts can aid in fortifying cultural systems against the adaptive challenges anticipated in the rapidly transforming Arctic [113].
Community-Based Adaptation to climate change involves engaging and empowering local residents, including Indigenous peoples, in identifying, planning, and implementing adaptation strategies that are tailored to their specific needs, priorities, and cultural contexts, and is built on the priorities, knowledge, and capacities of local people [114,115].Community-Based Adaptation draws on participatory approaches and methods developed in both disaster risk reduction and community development work, as well as sectoralspecific approaches such as farmer participatory research [114].Community-Based Adaptation to climate change in the Arctic refers to a localized approach to addressing the impacts of climate change within Arctic communities.It shows considerable potential in democratizing adaptation research and effectively addressing local needs, serving as a foundation for developing adaptations tailored to local and Indigenous contexts, integrating both traditional and Western knowledge [116].Climate change has the potential to cause harm to sanitation infrastructure, leading to disease transmission and jeopardizing a community's economic stability and cultural heritage, thus inducing mental distress.By monitoring key indicators, communities can initiate responses to climate change.Armed with this data, planners, engineers, healthcare practitioners, and governments can devise strategies to tackle the climate change-related challenges [117].
There is evidence indicating ongoing adaptation efforts in response to both the current and anticipated impacts of climate change.However, the readiness for adaptation is hindered by constraints such as limited resources, institutional capabilities, and the necessity for comprehensive support for adaptation across various levels of government.According to J. Ford et al., areas deserving priority attention for future research include: (i) broadening the scope of understanding climate change impacts, adaptation, and vulnerability across different sectors and geographical regions; (ii) integrating projections of both climatic and socioeconomic factors into vulnerability and adaptation assessments; (iii) establishing a robust evidence base concerning adaptation options; and (iv) monitoring and evaluating the effectiveness of support provided for adaptation efforts [118].In addition, overarching themes for advancing research on climate change impacts, adaptation, and vulnerability in the northern coastal regions include the imperative for interdisciplinary approaches and cross-cultural collaborations, fostering decision-oriented research, and emphasizing effective knowledge dissemination and utilization [12,13,22,25,45,89,118,119].Key elements of Community-Based Adaptation in the Arctic can include: active participation of community members in decision-making processes related to climate adaptation, drawing upon their knowledge of local environmental conditions, traditional practices, and livelihoods; as well as the integration of Indigenous and traditional knowledge into adaptation planning and implementation.Community-Based Adaptation approach in the Arctic recognizes that local communities are at the forefront of experiencing the impacts of climate change and are best positioned to identify effective solutions that meet their unique needs and circumstances [45][46][47]79,82,83,[114][115][116].

Different Levels of Adaptation Efforts: From Local to Regional, National, and International
Adapting to climate change in the Arctic requires a coordinated effort across multiple levels of governance, from local communities to regional and national governments, along with global international cooperation [36,84,88].
At the local level, Community-Based Adaptation approach implies that, despite the enormous challenges posed by climate change, there are opportunities to mitigate and manage its health impacts, dependent upon the collective community's efforts to recognize and address these challenges [45][46][47]56,65,67,75,78,79,82,83,95,102,115].At the regional level, cooperation among various stakeholders, such as local governments, Indigenous groups, research institutions, and industry partners, can promote the creation of comprehensive adaptation strategies that tackle interconnected challenges and effectively utilize shared resources [120].Setting up regional networks or platforms for adaptation enables the exchange of knowledge, builds capacities, and encourages mutual learning among Arctic communities, governments, and stakeholders [46,64,71,99,120].
At the national level, climate change adaptation considerations should be embedded into overarching policies, plans, and strategies spanning sectors like transportation, energy, health, and agriculture.This involves integrating adaptation into national development priorities and aligning them with global commitments such as the Paris Agreement.Dedicated funding should be allocated and financial mechanisms should be established to support adaptation efforts at the national level, including grants, subsidies, and incentives for climate-resilient infrastructure, technology adoption, and community-based adaptation projects.Investments should be made in research, monitoring, and data collection initiatives to improve the understanding of climate change impacts, vulnerabilities, and adaptation options at the national scale.This includes supporting scientific research, data sharing networks, and long-term monitoring programs to inform evidence-based decision making [49,50,52,60,80].
Strengthened collaboration among nations is essential to mitigate external impacts on the Arctic environment and prioritize public health, particularly the well-being of Indigenous communities in Arctic and sub-Arctic regions, to reduce external influences on the Arctic environment and to prioritize public health [40,53].As an example, the Lancet Commission on Arctic and Northern Health was launched as an international research collaboration institution to examine crucial health challenges facing Arctic and Northern Indigenous peoples, to explore the underlying factors that influence health and well-being, and develop a roadmap to improve the health of Indigenous peoples in the region [107].Another example is the International Circumpolar Surveillance network, which comprises hospitals, public health agencies, and reference laboratories across the Arctic region, with its mission to collect, compare, and share standardized laboratory and epidemiological data on infectious diseases of concern, collaborating in formulating prevention and control strategies to address these challenges [53].One more illustration is the world-wide efforts of the small workgroup Health Care Infrastructure at GEO4HEALTH, emphasizing the importance of investing in healthcare facilities and services that are equipped to address the health impacts of climate change, such as the increased incidence of infectious diseases, etc. [121].
To effectively address the complexities of climate-sensitive diseases in the Arctic, it is imperative to bolster support through collaborative efforts led by the Arctic Council and pertinent sovereign nations.This entails not only enhancing research and surveillance capabilities, but also fostering international interdisciplinary cooperation among stakeholders, including healthcare professionals, scientists, policymakers, and Indigenous communities [106,122].
By enhancing adaptation efforts at the local, regional, national, and international levels, Arctic communities and governments can effectively respond to the challenges posed by climate change and build resilience in the face of uncertainty.

Adaptation to Climate Change: Maladaptation and Opportunities
Adaptation planning aims to anticipate and mitigate the risks stemming from climate change, employing two main approaches: hard and soft adaptation, where hard adaptations means creating physical barriers to mitigate risks, such as constructing sea walls [25,27].In this paper, we discuss soft adaptations that conversely focus on modifying human behavior and endeavoring to reduce risk, achieved through methods like the enhancement of healthcare infrastructure or the development of early warning systems, and promoting environmental monitoring to enhance ecosystem services [25].However, there is a risk of maladaptation regarding soft adaptation, where adaptation measures unintentionally exacerbate negative consequences and further increase risks.For example, adapting infrastructure to climate change in the Canadian North poses significant challenges due to various limitations and constraints, including slow implementation, geographical isolation, low population density, and limited tax resources for local-level adaptation and infrastructure maintenance [25].
Societal factors such as income, housing quality, health status, and resilience at the individual or community level, or industrial developments, globalization, and shifts in societal norms at the regional or government level, contribute to vulnerability in regards to adaptation strategies in the Arctic, creating complex and interconnected effects on human health within and beyond the Arctic region [70,123].Further research on the intersection of climate change and health impacts on vulnerability could provide valuable insights for stakeholders to develop effective strategies aimed at mitigating the impacts of climate change [26,27,70].Addressing these challenges necessitates implementing location-specific strategies to reduce vulnerability, adopting low-risk, high-benefit policies, fostering intergovernmental cooperation, public engagement, and integrating Indigenous knowledge systems to achieve resilience and sustainably balance environmental risks with socioeconomic impacts.
On the other hand, climate change and its associated environmental alterations in the Arctic not only present challenges, but also offer opportunities, impacting local, regional, and international developments.Climate change may facilitate better access to Arctic resources, leading to increased human activities such as shipping and tourism [17].The warming Arctic presents an additional incentive for climate migration, attracting individuals from hot countries seeking to evade heat-related challenges, introducing hurdles and dangers to both migrants and host communities [124].Although migration could mitigate susceptibility to climate change, it remains imperative to enhance comprehension and address potential health implications for both migrant populations and their home or host communities.

Instead of Conclusions, Strategies for Adaptation to the Effects of Climate Change on Health in the Arctic
Adapting to climate change in the Arctic requires a multifaceted approach that addresses various aspects of human life and infrastructure.Adaptation strategies should address a wide range of climate-related risks and vulnerabilities, including changes in temperature, precipitation, sea ice, permafrost, wildlife migration patterns, and access to traditional food sources.This paper discusses the importance of understanding Arctic climate change as a global issue with far-reaching consequences for human health in the northern areas.Through comprehensive analysis and synthesis of scientific research, this paper sheds light on the complex impacts of climate change on human health in the Arctic, underscoring the urgent need for concerted global efforts to mitigate its effects and adapt to the changing environment.Adaptation strategies, summarizing the findings from the papers reviewed above, can include several main aspects.
Enhanced Healthcare Infrastructure: This strategy involved investing in healthcare facilities and services that are equipped to address the health impacts of climate change, such as increased incidence of infectious diseases, mental health issues, and injuries resulting from extreme weather events; developing and retrofitting infrastructure to withstand the impacts of thawing permafrost, including changes in ground stability, increased erosion, and infrastructure damage; and ensuring that healthcare facilities are equipped to handle cold-related illnesses and injuries, including hypothermia and frostbite.
Early Warning Systems: These should be developed for extreme weather events, such as heatwaves, storms, and wildfires, and permafrost thawing conditions, to enable timely evacuation and emergency response efforts, including emergency phone calls/messages.
Emergency Preparedness: This includes developing robust emergency response plans and stockpiling essential supplies such as food, water, and medical supplies to help communities cope with extreme heat and cold events, as well as disruptions to transportation and services.
Surveillance and Monitoring: These efforts include establishing monitoring networks to detect changes in permafrost conditions and anticipate potential hazards such as land subsidence, landslides, and flooding.Surveillance and monitoring systems should be established to track climate change-related health indicators, such as changes in the prevalence of vector-borne diseases, respiratory illnesses, and mental health disorders.
Water and Sanitation Infrastructure: This adaptation ensures access to safe drinking water and adequate sanitation facilities, particularly in remote Arctic communities, to reduce the risk of water-borne diseases and improve overall public health.
Food Security Initiatives: These initiatives support food security and promote access to nutritious and culturally appropriate food sources, as changing climate conditions may impact traditional hunting, fishing, and gathering practices.
Cultural Resilience: Cultural practices that contribute to resilience and well-being in the face of climate change-related health challenges should be adopted.Supporting cultural practices that are adapted to cold weather conditions, such as winter festivals or traditional outdoor activities like ice fishing and dog sledding, can help maintain community wellbeing and resilience in the face of extreme cold.
Promoting Traditional Knowledge and Community-Based Adaptation: Recognizing and respecting Indigenous knowledge systems and traditional ways of knowing is essential for effective climate change adaptation.Implementation of Community-Based Adaptation and health promotion programs to raise awareness about climate change-related health risks can empower individuals and communities to take proactive measures to protect their health.
Education: Education initiatives can involve local communities in understanding the science behind climate change, its specific impacts on the Arctic region, and how individuals can contribute to mitigation and adaptation efforts.Empowering communities with knowledge and skills enables them to actively participate in decision-making processes and take ownership of the adaptation measures tailored to their unique needs.
Research and Collaboration: EcoHealth principles, including systems thinking and interdisciplinary collaboration, and One Health strategy, should be implemented, effectively tackling the impacts of climate change spanning communities, ecosystems, and landscapes, integrating climate change adaptation considerations into health policies and planning processes at the local, regional, and national levels to ensure that health needs are effectively addressed in climate change adaptation efforts.Investing in research and monitoring programs to better understand the impacts of climate and weather on human health, infrastructure, and ecosystems can inform the development of more effective adaptation strategies and policies.
International Cooperation: This adaptation fosters collaboration and knowledgesharing among Arctic nations, Indigenous organizations, and international partners to address the transboundary nature of climate change challenges.International cooperation enables the pooling of resources, expertise, and best practices to develop effective adaptation measures that benefit Arctic communities and ecosystems.
Policy Integration: Collaboration between government agencies, educational institutions, non-profit organizations, Indigenous communities, and other stakeholders is crucial for advancing climate change adaptation in the Arctic, integrating climate change adaptation considerations into health policies and planning processes at the local, regional, and national levels to ensure that health needs in the Arctic are effectively addressed by climate change adaptation efforts.
By recognizing the interconnected nature of climate change challenges in regards to human health in the Arctic, effective strategies to protect vulnerable populations and promote resilient communities in the face of ongoing environmental changes should be developed.Addressing the health impacts of climate change in the Arctic requires holistic and adaptive strategies that encompass public health interventions, infrastructure improvements, community resilience building, and policy initiatives informed by Indigenous knowledge and perspectives; prioritizing interdisciplinary research, community engagement, and collaborative action; developing effective mitigation and adaptation measures to protect human health and enhance resilience in the face of climate-induced changes in the Arctic.

Figure 1 .
Figure 1.Climate change challenges, human health outcomes, and adaptation strategies in the Arctic.

Figure 1 .
Figure 1.Climate change challenges, human health outcomes, and adaptation strategies in the Arctic.

Table 2 .
Climate change and human health of the Arctic population: manifestation and adaptation strategies.