Participation and Engagement of Public Health Stakeholders in Climate and Health Adaptation

Round 1

Reviewer 1 Report

The authors have made some changes to address the concerns raised from the first review of the paper. Here are the comments for the second review.

Introduction section: This section is still lacking the following essential information:

What is the problem being addressed? Why is there need for this research? Why are these case studies relevant? What do they tell us about what is happening elsewhere? What are the similarities and differences from other examples of networks? What can be learnt? What is needed to improve engagement and participation? What are the facilitators and barriers?

There are no definitions of ‘participation’ and ‘engagement’ and what they entail. The authors need to address this engaging with appropriate literature.  

Results section: What are stakeholders’ views about the networks and engagement? There is no mention of engagement with participants/stakeholders views regarding the networks, their role and lessons learnt. The quantitative data presented and the stakeholder mapping although important do not help explain the problems of engagement and participation.

Conclusions section: Lines 406-407 this is not a conclusion from the research done. What is the evidence within your work regarding this? Is it just a problem of funding? What more could be done if there was more funding? How could things be done better? What about allocation of funding? What would be the priorities? Any issues in relation to diversity of stakeholders, that need addressing?  All these issues need to be addressed in previous sections in order to take their place in the conclusions.   

Author Response

The authors have made some changes to address the concerns raised from the first review of the paper. Here are the comments for the second review.

Introduction section: This section is still lacking the following essential information:

What is the problem being addressed? Why is there need for this research? Why are these case studies relevant? What do they tell us about what is happening elsewhere? What are the similarities and differences from other examples of networks? What can be learnt? What is needed to improve engagement and participation? What are the facilitators and barriers?

We have added to the introduction to address the problem, the need, and why it is relevant to share. We have also provided an in-depth background on the programs to share the history of how these programs have developed over time with stakeholder engagement. We also cited an important report from the GAO that highlights some of the challenges we hope to address with this paper.

There are no definitions of ‘participation’ and ‘engagement’ and what they entail. The authors need to address this engaging with appropriate literature. 

We have clarified what we mean by participation and engagement of stakeholders in section 1.1 as well as provided references. We have used the two key features of participation and engagement in this work by highlighting iterativity and co-production, along with appropriate literature.

Results section: What are stakeholders’ views about the networks and engagement? There is no mention of engagement with participants/stakeholders views regarding the networks, their role and lessons learnt. The quantitative data presented and the stakeholder mapping although important do not help explain the problems of engagement and participation.

Thank you for this insight. We have added the stakeholder input and tangible results from this input into the discussion section (e.g. heat story series, funded grant). Their role shouldn’t be understated as many of the efforts we’ve been able to accomplish came directly from stakeholder feedback. We have tried to make that clear in the discussion.

Conclusions section: Lines 406-407 this is not a conclusion from the research done. What is the evidence within your work regarding this? Is it just a problem of funding? What more could be done if there was more funding? How could things be done better? What about allocation of funding? What would be the priorities? Any issues in relation to diversity of stakeholders, that need addressing?  All these issues need to be addressed in previous sections in order to take their place in the conclusions.  

Unfortunately lines 406-407 are part of the author contributions section so we weren’t positive what line you were referring to here. However, we have reviewed the conclusions section and integrated your feedback you provided making it more in line with the results and scope of the paper.

Reviewer 2 Report

The authors have adequately responded to my comments from the first review. I recommend accepting the article for publication

Author Response

The authors have adequately responded to my comments from the first review. I recommend accepting the article for publication

                Thank you for your review and comments on our manuscript.

Reviewer 3 Report

No additional suggestion for changes. Just one reflection. In line 55 you argue that: Local and regional climate-sensitive hazard work is most effective when it is cross-disciplinary. However later in this section you write "Coproduction, is a deliberate approach to building stakeholder networks in order to conduct collaborative and more effective research."Shouldn't your argument be then that local and regional climate-sensitive hazard work is most effective when it is transdisciplinary?

Author Response

No additional suggestion for changes. Just one reflection. In line 55 you argue that: Local and regional climate-sensitive hazard work is most effective when it is cross-disciplinary. However later in this section you write "Coproduction, is a deliberate approach to building stakeholder networks in order to conduct collaborative and more effective research. Shouldn't your argument be then that local and regional climate-sensitive hazard work is most effective when it is transdisciplinary?

Thank you for your reflection here. Yes, we agree that it is more effective when it is transdisciplinary. We have made that change to the section 1.1 to reflect this as well as throughout the paper when needed.

Round 2

Reviewer 1 Report

Thank you for all your changes, the paper has been improved to a good standard.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

The article has an interesting title but does not fulfil its objectives. It aims to focus on an important topic of engaging public health stakeholders in climate and health adaptation.

This paper reads more as report than a research paper. It generates some data on the types of stakeholders being engaged but not much more. As an empirical study, this contribution is somewhat limited.

In the end, the paper makes not enough of a contribution to knowledge to warrant publication in the journal.

There are a couple of comments that I can make for improvement.  1) presenting more research findings which are lacking; 2) making specific recommendations about how those stakeholders can be helped in enhancing their engagement, given the findings; and 2) what is the role of individuals and agencies, especially those in climate and health adaptation in supporting engagement?

Author Response

The article has an interesting title but does not fulfil its objectives. It aims to focus on an important topic of engaging public health stakeholders in climate and health adaptation.

Thank you for this comment. We have changed the article title to more accurately reflect the topic of the paper.

This paper reads more as report than a research paper. It generates some data on the types of stakeholders being engaged but not much more. As an empirical study, this contribution is somewhat limited. In the end, the paper makes not enough of a contribution to knowledge to warrant publication in the journal. There are a couple of comments that I can make for improvement.  1) presenting more research findings which are lacking; 2) making specific recommendations about how those stakeholders can be helped in enhancing their engagement, given the findings; and 2) what is the role of individuals and agencies, especially those in climate and health adaptation in supporting engagement?

We have added more findings on the effects of the stakeholder network throughout the paper. The purpose for this work was to show the benefit of analyzing our network so that we can generate more collaborative, effective networks in the climate and health field. We have added to the discussion to show how doing this first step can help fill gaps in future projects and the role of public health personnel in these agencies to support engagement.

Reviewer 2 Report

The article shares information about the level of participation of professional stakeholders in two local climate change and health initiatives in Arizona and the surrounding region.

While it shares useful information about local and regional climate and health case studies, the current draft of the article does not clearly frame a study scope or research question. Specifically:

A new section should be added to the introduction prior to the current section 1.1 that clearly explains what “Stakeholder participation at the intersection of climate and health” means within the scope of this article. It is currently unclear at the beginning of the article why the authors are talking only about the role of public health, since climate change initiatives are almost always cross-disciplinary in nature – particularly at the local level. It would be very helpful for the authors to lay out: 1) the types of initiatives that are relevant to the article (e.g., Climate vulnerability assessments? Climate adaptation plans? Climate action plans? Environmental public health indicators? Etc.), 2) relevant geographic/political scales (e.g., local, regional, state, etc.), 3) the types of agencies/departments/sectors that often participate (e.g., public health, emergency management, environment, flood control, utilities, sustainability, office of the executive (mayor? governor?), parks, housing, etc.) in these policies/initiatives, and 4) which agencies generally lead the effort. The authors could then reference this framework when they introduce the Arizona case studies on p. 2, lines 77-93. That way, the reader will feel more oriented about where the topic of the article fits within the larger context of how climate change and health public policies and initiatives are organized and staffed nationwide. P. 2, lines 77-93 (and, possibly, Table 1) should also be expanded to explain which agencies/departments/sectors officially partnered with ADHS on each of the BRACE projects. Did those BRACE projects coordinate with other ongoing climate change work that was spearheaded by other departments? Finally, there is a disconnect between the end of the current section 1.1 and section 1.2. The authors need to state the gap in research that they are attempting to fill with the study outlined in the article. Currently, no argument is made to support the need for stakeholder mapping. P. 3, lines 97-105: It is currently unclear why iterativity was mentioned.

 

Discussion Section:

This section should be expanded to explain the significance of the results of the stakeholder mapping. In particular:

Why is this study relevant to readers from other local health departments? What value did the variety of stakeholders bring to the projects that were funded through BRACE and CCCPH? What are the limitations of the study?

Conclusion:

This section makes very good points about the inconsistency and inadequacy of climate and health funding. But, it is not clear how those points are related to the results of the stakeholder mapping exercise. Is the idea that public health departments can lean on other stakeholders to help carry some of their load, since they are underfunded? Or, is the article trying the make the argument for a broad coalition of agencies and sectors joining together to advocate for high levels of cross-disciplinary funding?

Finally, I found a typo on p. 2, line 69 (should read “adaptation”). The authors are encouraged to spell-check and copy edit the article prior to publication.

Author Response

The article shares information about the level of participation of professional stakeholders in two local climate change and health initiatives in Arizona and the surrounding region. While it shares useful information about local and regional climate and health case studies, the current draft of the article does not clearly frame a study scope or research question. Specifically:

We have included the purpose for sharing this work at the end of the introduction as well as added more detail to relate the objective to the rest of the document.

A new section should be added to the introduction prior to the current section 1.1 that clearly explains what “Stakeholder participation at the intersection of climate and health” means within the scope of this article. It is currently unclear at the beginning of the article why the authors are talking only about the role of public health, since climate change initiatives are almost always cross-disciplinary in nature – particularly at the local level. It would be very helpful for the authors to lay out: 1) the types of initiatives that are relevant to the article (e.g., Climate vulnerability assessments? Climate adaptation plans? Climate action plans? Environmental public health indicators? Etc.), 2) relevant geographic/political scales (e.g., local, regional, state, etc.), 3) the types of agencies/departments/sectors that often participate (e.g., public health, emergency management, environment, flood control, utilities, sustainability, office of the executive (mayor? governor?), parks, housing, etc.) in these policies/initiatives, and 4) which agencies generally lead the effort. The authors could then reference this framework when they introduce the Arizona case studies on p. 2, lines 77-93. That way, the reader will feel more oriented about where the topic of the article fits within the larger context of how climate change and health public policies and initiatives are organized and staffed nationwide.

We have re-organized a paragraph in the article to address this comment and the importance of cross-disciplinary work in this field. We hope to encourage climate scientists to engage with public health more to address climate and health hazards in their region. To address, this we added some clarifications throughout the introduction to orient the reader to our purpose and objectives. We clarified the scope and type of agencies that have led these efforts in the past in Table 2 and gave more context to how the networks developed.

2, lines 77-93 (and, possibly, Table 1) should also be expanded to explain which agencies/departments/sectors officially partnered with ADHS on each of the BRACE projects. Did those BRACE projects coordinate with other ongoing climate change work that was spearheaded by other departments?

We have added the agencies who partnered with ADHS on each of the projects on Table 1 and also clarified the roles of the agencies in the larger BRACE program

Finally, there is a disconnect between the end of the current section 1.1 and section 1.2. The authors need to state the gap in research that they are attempting to fill with the study outlined in the article. Currently, no argument is made to support the need for stakeholder mapping. P. 3, lines 97-105: It is currently unclear why iterativity was mentioned.

We have tied iterativity more tightly into the objective and purpose of this paper by moving the section higher up in the introduction. We also highlighted the purpose for the stakeholder mapping as a first step to address gaps in current and future projects in this area.

 Discussion Section:

This section should be expanded to explain the significance of the results of the stakeholder mapping. In particular:

Why is this study relevant to readers from other local health departments? What value did the variety of stakeholders bring to the projects that were funded through BRACE and CCCPH? What are the limitations of the study?

We added a sentence about why this is relevant for other local health departments in the beginning of the discussion. We added some commentary on the value that a variety of stakeholders, like our News Agency folks, brought to the projects. We have also included some limitations of the stakeholder network.

Conclusion:

This section makes very good points about the inconsistency and inadequacy of climate and health funding. But, it is not clear how those points are related to the results of the stakeholder mapping exercise. Is the idea that public health departments can lean on other stakeholders to help carry some of their load, since they are underfunded? Or, is the article trying the make the argument for a broad coalition of agencies and sectors joining together to advocate for high levels of cross-disciplinary funding?

Thank you for this comment. We have clarified the connection between needing funding and the stakeholder networks further.

Finally, I found a typo on p. 2, line 69 (should read “adaptation”). The authors are encouraged to spell-check and copy edit the article prior to publication.

                We have spell-checked and copy edited the article prior to re-submission.

Reviewer 3 Report

 I cannot find a a clear research question/hypothesis. You have stipulated an research objective "to describe the the scientist public health stakeholder collaboratives. But I would follow up with a why? Perhaps you answer can be found in the conclusion, Continuous funding in this field will catalyze collaborative adaptation and mitigation efforts, thereby reducing the human health impacts of climate-sensitive hazards.

Author Response

I cannot find a a clear research question/hypothesis. You have stipulated an research objective "to describe the the scientist public health stakeholder collaboratives. But I would follow up with a why? Perhaps you answer can be found in the conclusion, Continuous funding in this field will catalyze collaborative adaptation and mitigation efforts, thereby reducing the human health impacts of climate-sensitive hazards.

We have added a few sentences throughout to clarify our purpose for writing this article. We have also stated our purpose for sharing this work at the end of the introduction.