On the need to better integrate the social environment in research on climate change and health: recommendations and thinking tools.

Social inequality impacts health, is aggravated by the consequences of climate change, and may be influenced by inappropriate policy responses. These interdependent effects create a self-perpetuating loop exacerbating the impact of climate dysregulation on health in an uncontrolled and poorly understood way. Holistic approaches to public health such as One Health, EcoHealth or Planetary Health are well suited to tackling the considerable and complex environmental and social issues underlying climate dysregulation. However, the extent to which research using such frameworks investigates social determinants of health is not clear. In this paper we discuss the ways in which the social environment has so far been considered in the literature to problematize and analyze the relationship between climate dysregulation and health within holistic frameworks and provide tools and recommendations to facilitate their apprehension. Social factors are investigated empirically only in a minor fraction of studies addressing the relation between climate and health in holistic frameworks, and not systematically. Barriers to such approaches are discussed. This work also provides two analytical tools (a process diagram and a knowledge framework) and a set of recommendations to help include the social environment more meaningfully in such frameworks. They are meant to facilitate our understanding of the current status of this type of research and to encourage trans-disciplinary and trans-sectorial endeavors towards directions which need to be taken to ensure societal factors and inequalities are placed at the center of research on climate and health and the ensuing policy response.