Social vulnerability to health impacts of climate change in Australia: understanding dimensions, drivers, and health inequality

BackgroundA limited ability to identify social vulnerability and community resilience at local scales has been recognised as a critical barrier to both climate adaptation and health risk assessment and planning. This study aims to assess multidimensional social vulnerability to the health impacts of climate change across communities in Australia, quantify its contribution to health inequalities, and identify key drivers of health vulnerability. MethodsInformed by a scoping review and the WHO Social Determinants of Health Equity framework, we compiled area-level data from multiple sources on 61 social vulnerability indicators, subsumed under 27 subdomains and 8 domains (demographic profile, economic security, residential environment, infrastructure and services, social stability and community support, population health, governance and policies, climate knowledge and awareness). These indicators were used to construct a Social Vulnerability Index for the Health Impact of Climate Change (SVI-HICC) and scores in each domain. We used dominance analyses to identify the strongest predictors of vulnerability, examined inequalities in mental, physical, and social health associated with extreme weather and climate events across the vulnerability distribution, and tested the capacity of SVI-HICC to predict adverse health outcomes following climate-related extreme events in comparison to alternative social indices. FindingsSpatial mapping showed that high vulnerability was clustered in regional and remote areas, with pockets of moderate vulnerability in urban areas. People living in high vulnerability areas experienced significant health losses from weather and climate disaster, this was not seen for people in low vulnerability areas. Infrastructure and services, economic security, and residential environment were identified as the most influential domains contributing to social vulnerability, primarily driven by access to healthcare services, area disadvantage, dwelling condition, and housing precarity. InterpretationAn area-level assessment of multi-dimensional social vulnerability makes visible how social and structural determinants contribute to health inequalities in climate change. Such insights can inform climate adaptation policies that are equity-oriented and context-sensitive.