How can the response to climate change and health challenges in the Caribbean be strengthened? The study "Research for Action Agenda on Climate Change and Health in the Caribbean", by Caroline F. Allen, Robert Dubrow, C. James Hospedales and Saria Hassan, published in Washington in 2026 by the Pan American Health Organization (PAHO), answers with a synthesis of the available scientific evidence and a set of operational recommendations.

The analysis of the 18 priority areas yields 12 cross-cutting recommendations. The first is to involve communities and civil society organizations in decision-making: people on the front lines know water management, pollution and vector control, while people with chronic diseases can advise on how to protect themselves. The second is to integrate the health sector into climate policy, with collaboration mechanisms across levels of government and data-sharing systems. Next come cooperation across disciplines and agencies, a commitment to climate justice, including through international finance on an adequate scale, and training for health workers, with climate and health built into the curricula of health professions.

Other recommendations concern education and communication, with early warning systems that include health risks, and stable financial resources: parametric disaster insurance, dedicated funds, cost-benefit analyses, and the inclusion of costs in national budgets and Nationally Determined Contributions (NDCs). Also weighing in are resilient infrastructure and hospitals, such as those under PAHO's Smart Health Facilities Initiative; green investments with health co-benefits (renewables in place of fossil fuels, green spaces, active mobility, rainwater harvesting, coastal protection, plant-based diets); and stronger research and surveillance, integrating climate and health data.

On extreme events, a study in Puerto Rico estimated that deaths in the three months after Hurricane Maria were about 70 times higher than official estimates, which counted only immediate trauma and drowning. In the months after a hurricane, mortality from noncommunicable diseases far exceeds immediate deaths. For this reason, the study calls for emergency plans that protect older people, people with disabilities and the chronically ill; supply chains for medicines and food; psychological support; and rapid restoration of water and power. Ecosystems such as coral reefs and mangroves reduce the health effects of extreme events, and their conservation is part of adaptation.

On heat, the report draws on Lancet Countdown data for small islands. Potential work hours lost, especially in agriculture, rise over the 1990-2023 period. The measures indicated include national heat-wave plans, air-conditioned shelters, sustainable cooling of hospitals, schools and care homes (ideally below 32 °C by day and 24 °C at night in living spaces), and rules for outdoor workers, with breaks, shade and adjusted schedules. For dengue and other vector-borne diseases, the strategy combines a One Health approach, integrated vector management and community clean-ups of standing water, since the Aedes aegypti mosquito can fly up to 200 meters from its breeding site. One Caribbean contribution is "climate services," which combine meteorological and epidemiological data to predict outbreaks.

As for gaps, the study highlights a lack of integration between health and meteorological data, data sharing, cost-effectiveness assessments and studies on disadvantaged groups. Research on the health effects of ocean changes and of funding is almost absent, and for climate-smart agriculture the health benefits have not been measured. This is also why, according to the authors, the move from political commitments to action remains slow.

The work was carried out by PAHO with Blue Sky Development Consulting, the Center on Climate Change and Health at the Yale School of Public Health, the EarthMedic and EarthNurse Foundation for Planetary Health, the Rollins School of Public Health at Emory University and the University of the West Indies.

The Caribbean's small island developing states face more intense hurricanes, floods, droughts, extreme heat and sea level rise. These hazards are compounded by structural weaknesses such as a small health workforce, economic vulnerability, geographic isolation, and populations and infrastructure concentrated along the coasts. The consequences build on existing conditions, such as the high incidence of noncommunicable diseases at relatively young ages, socioeconomic inequalities and an environment favorable to the breeding of vectors.

The Caribbean Community (CARICOM) has repeatedly named climate as a regional priority, but the study notes that turning this into action is held back by siloed approaches and by gaps in data, research, funding and surveillance tailored to the local context. The Research for Action on Climate Change and Health in the Caribbean initiative began after the Third Global Conference on Health and Climate Change, with a focus on small islands, promoted by the World Health Organization in 2018. The report is the abridged and updated version of the 2024 agenda "Research for Action on Climate Change and Health in the Caribbean: A public, private, people's and planetary agenda," designed to make its findings more accessible to decision-makers, health professionals, civil society and the public.

The process has two components: a regional consultation, which identified 18 priority areas in four domains (impacts, exposures and vulnerability; adaptation, planning and resilience; mitigation and health co-benefits; resources and engagement), and a review of Caribbean evidence for each area. In 2021, a four-day online conference, backed by more than 25 organizations, brought together 162 presenters and 642 participants from 80 countries. The areas were then discussed in 16 meetings with about 70 representatives of 14 academic, civil society, government and professional organizations.

The analysis rests on a framework derived from the Lancet Countdown. A narrative review was chosen for the evidence, suited to an emerging field: targeted PubMed searches using terms such as "Caribbean" and "climate change," analysis of conference presentations and of documents from regional technical agencies and United Nations bodies. Where Caribbean literature was lacking, the authors inferred likely effects from global findings. Each chapter distinguishes what is happening, what should be done and what needs to be known. The drafts were reviewed by Caribbean experts and discussed in an online workshop in May 2023 with 78 participants.