Climate Change and Human Health in the Arctic: A Review

Abstract

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.

1. 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 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 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 km² (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.

2. 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.

3. Results

From the 56 reviewed papers, 53 in English and 3 in Russian were included in the Table. A total of 25 papers discuss the impacts of climate change on human health across various Arctic regions, addressing factors such as an increase in the mean annual or seasonal temperatures, alterations in precipitation patterns, sea level rise, permafrost degradation, and others. These changes pose heightened risks to overall human health in its different aspects (8) [45,46,47,48,49,50,51], including infectious disease, which represent a significant and frequent category regarding mortality and morbidity (13) [52,53,54,55,56,57,58,59,60,61,62,63,64], and mental health conditions (4) [63,64,65,66]. The remaining 31 papers focus on specific consequences of climate change, including extreme weather events like heat waves or cold spells, or cold climate implications in general (12) [67,68,69,70,71,72,73,74,75,76,77,78,79,80]. Additionally, topics such as wild fires and the associated air pollution (4) [81,82,83,84], permafrost degradation (5) [85,86,87,88,89], and health challenges connected with the impact of climate change on food and water security in the Arctic (10) [90,91,92,93,94,95,96,97,98,99], are explored. Most of the articles were studies from Russia (17) [50,51,58,63,73,74,75,76,79,83,84,85,86,87,90,91,93], Canada (14) [44,46,48,54,57,62,66,67,68,88,94,95,97,99] and the USA (Alaska) (10) [46,55,56,70,71,81,82,92,96,98]; with (3) from Finland [72,77,78], (1) from Norway [47], and (1) from Sweden [69]; several papers (10) summarize results for the whole northern area or several Arctic countries [49,52,53,59,60,61,64,65,80,89]. The studied papers provide research results regarding outcomes for human health resulting from climate change for the whole country or several countries in the Arctic, regions inside the country, an individual city or cities, or an Indigenous community or communities.

3.1. Climate Change Risks for Human Health

3.1.1. 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]. These health challenges are deemed crucial across all Arctic regions [49], in particular, spanning communities in the USA (Alaska) [45], Norway [47], Canada’s northern regions [44,46,48], and the Russian Far North [50,51].

3.1.2. 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 food-borne 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. Pathogens and their associated health consequences in Arctic and Subarctic regions.

#	Study Area: [Study]	Pathogen(s)	Source/Causal Factor	Health Consequences
1	USA: Alaska, Northwest communities of Point Hope and Kivalina [45]	Not reported	Poor sanitation/no running water; damage and disruption of water and sanitation infrastructure	Higher rates of respiratory and skin infections: from 44 visits/year in 2004 to 140 in 2007
2	Canada: Labrador, Nunatsiavut, communities of Rigolet and Iqaluit [44]	E. coli, Salmonella	Delayed shipment of retail foods	Increased rate of food-borne disease
3	The Arctic: Indigenous communities [49]	Bacillus anthracis	Prolonged warm periods expand the habitats of rodent and insect vectors; reappearance of pathogens from melting permafrost in cattle burial sites due to temperature anomaly	Higher risk of respiratory infections; diseases like tularemia, leptospirosis, tick-borne encephalitis, hemorrhagic fever with renal syndrome, and pseudotuberculosis; major epizootic event among reindeers in Russia in summer 2016
4	Russia: Arctic regions [50]	Not reported	Rising air temperatures	Expansion areas inhabited by vectors of human infectious diseases; elevated risk of water-borne infections, including parasitic, bacterial, and viral diseases
5	Sweden, Finland: northern Scandinavia [52]	V. cholerae	Extreme heat wave in summer 2014	70 cases (3–93 years old); one fatality
6	Sweden, Finland: Arctic communities [53]	Streptococcus pneumoniae, Haemophilus influenza, Helicobacter pylori, Neisseria meningitides; group A and B streptococcus	Higher temperatures	Spread of zoonotic infections, antibiotic resistance, re-emergence of tuberculosis, rise in HIV, potential pandemic influenza, sudden emergence of new viral pathogens
7	Canada: northern communities [54]	Salmonella, Shigella, Vibrio cholera, Campylobacter, Helicobacter pylori, pathogenic strains of Escherichia coli; Enteroviruses, Rotaviruses, and norovirus (Caliciviridae); Giardia lamblia, Cryptosporidium	Exposure to microbial hazards in wastewater	Acute gastrointestinal illness (salmonellosis, cholera, shigellosis, other enteric infection) and more severe health conditions
8	USA: Arctic and subarctic regions [55]	Ichthyophonus, Giardia, Cryptosporidium, Echinococcus), food-borne parasites (Toxoplasma, Trichinella), vector-borne pathogens (tularemia, California encephalitis virus, Northway virus); rabies; hantaviruses, Rickettsia, Bartonella, tularemia	High temperatures, rainfall, humidity	Increased risk of food-borne, water-borne, and vector-borne diseases
9	USA: Alaska, rural communities [56]	Betacoronavirus SARS-CoV-2	Inadequate water and sanitation services	Spread of COVID-19
10	Canada: Arctic regions [57]	Cryptosporidium, Campylobacter, and Helicobacter pylori	Rapid environmental transformation	Increase in gastrointestinal infections and acute gastrointestinal illness
11	Russia: Salekhard [58]	Bacillus anthracis	Abnormally high temperatures	Anthrax: 12-year-old boy died, five adults and two additional children were confirmed to have contracted the disease, 63 individuals evacuated; 2300 reindeer perished
12	Greenland, Iceland, Norway, Sweden, Finland, parts of northern Russia [59]	Borrelia, Leptospira, tick-borne encephalitis viruses, Puumala orthohantavirus, Cryptosporidium, Coxiella burnetii	Rising temperatures and increased precipitation	Higher incidences of borreliosis, leptospirosis, tick-borne encephalitis, Puumala virus infection, cryptosporidiosis, and Q fever
13	Arctic regions [60]	Giardia lamblia, Cryptosporidium parvum	Higher ambient temperatures	Increase in food-borne diseases (gastroenteritis, paralytic shellfish poisoning, and botulism), zoonoses, water-borne, and arthropod vector infections
14	Arctic regions [61]	Brucella spp., Toxoplasma gondii, Trichinella spp., Clostridium botulinum, Francisella tularensis, Borrelia burgdorferi, Bacillus anthracis, Echinococcus spp., Leptospira spp., Giardia spp., Cryptosporida spp., Coxiella burnetti, rabies virus, West Nile virus, hantaviruses, and tick-borne encephalitis viruses	Higher ambient temperatures	Shifts in geographic and temporal distribution of a range of infectious diseases
15	Canada: Arctic regions [62]	Jamestown Canyon virus, Orthobunyavirus; snowshoe hare virus	Rising temperatures; northward shifts of hosts and vectors	Increase in the rate of vector-borne diseases
16	Russia: Komi Republic [63]	Tick-borne encephalitis viruses	Rising temperatures	Rise in tick-borne encephalitis incidence
17	Russia, Canada: Arctic regions [64]	Tick-borne encephalitis viruses, Francisella tularensis, Bacillus anthracis, vibriosis	Rising temperatures, increased precipitation	Increase in tick-borne diseases, tularemia, anthrax, and vibriosis

below provides more details regarding the main pathogens and their related health consequences in the northern regions.

3.1.3. Climate Change and Mental Health

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].

3.2. Specific Consequences of Climate Change and Human Health

3.2.1. 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].

3.2.2. 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].

3.2.3. 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].

3.2.4. 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].

3.3. 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].

The findings from the aforementioned research studies are documented in Table 1 and

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

##	Main Aspects (Risks) of CC to HH	Study Area: Country, Region, City/Community(ies) [Study]	Study Population	Timeline	Manifestation	Adaptation/Mitigation Efforts/Additional Notes
1	Climate-sensitive health priorities	USA: Alaska, northwest communities of Point Hope and Kivalina [45]	Inupiat Eskimos	2000–2010	Exacerbating susceptibility to injury, disease, mental stress, food and water insecurity	Community-specific information, merging traditional knowledge with modern technology: satellite technologies locate hunters in distress, reducing injury risks; upgraded shore defenses deter erosion, safeguard vital infrastructure, and alleviate psychological strain; more resilient and condition-appropriate water systems, testing water quality and monitoring lake water conditions
2		Canada: northern Aboriginal communities in Québec and Labrador [46]	Inuit	2000–2001	Increased morbidity and mortality from extreme temperatures; more accidents during hunting and travel; greater susceptibility to skin cancers, burns, infections, eye conditions, weakened immune responses; higher risk of vector- borne diseases; emergence of new health threats; psychological strain from community displacement; increased respiratory and cardiovascular disorders; greater exposure to environmental pollutants and their health effects	Strengthening local abilities to recognize, carry out, and assess climate change-related data and its impact on health strategies; fostering local and regional capacities for monitoring, analysis, and decision making; collaborative project planning and development within Inuit communities
3		Canada: Labrador, Nunatsiavut, communities, Rigolet, and Iqaluit [44]	Inuit	2010	Food and water security, mental health and well-being, emerging hazards and safety concerns, healthcare services and delivery	EcoHealth principles: systems thinking, interdisciplinary collaboration, community engagement, social and gender inclusivity, translation of knowledge into action
4		Norway: Kautokeino [47]	Sámi	2017	Linking the impacts of climate change to cultural heritage and practices; health-seeking behavior combines traditional and Western medicine due to social and structural barriers	Adaptation programs: cultural initiatives and traditions; reintroducing health professionals into Sámi siidas, offering individual therapy outdoors; investigation of the role of women in Sámi health
5		Canada: Northwest Territories, Paulatuk [48]	Inuvialuit	2016	Climatic stressors impact the accessibility and abundance of fish and wildlife, rendering travel conditions increasingly unpredictable and hazardous	Acknowledge the role of pre-existing environmental and societal stressors and their diversity within communities
6		Arctic Indigenous communities [49]	Indigenous peoples	2023	Growing threats to traditional food sources due to the rise and spread of new and existing diseases (anthrax); permafrost thawing and alterations in forest fires jeopardize the built environment and infrastructure	Strengthening the early warning system for heatwaves, high air pollution, and floods; identifying the most susceptible demographic groups in specific regions, including individuals aged ≥65 y; instituting surveillance measures for emerging diseases in both wildlife and human populations
7		Russia: Arctic regions [50]	Entire population, including Indigenous minority peoples of the North	2022	Increase in summer mortality and simultaneous reduction in winter mortality; additional challenges to the traditional land management practices of Indigenous peoples; threatens the integrity of food storage facilities in permafrost regions	Improvement of the health care system; assistance in emergency situations, including permafrost degradation and abrasion of coastal zones; development of early warning systems for weather and climatic anomalies
8		Russia, Arctic cities: Murmansk, Kandalaksha, Arkhangelsk, Naryan-Mar, Salekhard, Anadyr, Nadym [51]	Entire population	1966–2017	Transitional seasons (April-May and October-November) make the greatest contribution to the change in comfort; decreased number of days with severe cold stress	Climate becomes less rigid and more comfortable
9	Infectious diseases	Sweden, Finland: northern Scandinavia [52]	Entire population	2014– 2015	Severe heat wave in summer 2014 resulted in historically high sea surface temperatures, triggering the presence of Vibrio bacteria	Effective management and reduction of water-borne infectious disease risk: enhanced epidemiological surveillance and reporting; improved diagnostic capabilities; increased clinical awareness of emerging pathogens
10		Sweden, Finland: Arctic communities [53]	Entire population	1996–2015	Northward spread of zoonotic infections; emergence of antibiotic resistance among bacterial pathogens; resurgence of tuberculosis; entrance of human immunodeficiency virus; emergence and introduction of pandemic influenza or new viral pathogens	International Circumpolar Surveillance: successful collaborative surveillance and research for sharing knowledge, methods, and surveillance data
11		Canada: Northern communities [54]	[53] Inuit	1995–2016	Climate change affects management of wastewater, exposure to microbial hazards in wastewater, acute gastrointestinal illness, and more severe health conditions	Challenges regarding an accurate estimation of the disease burdens linked to wastewater exposures: datasets, models, and assumptions
12		USA: Arctic and subarctic regions [55]	Entire population, Indigenous peoples	1967–2015	High temperatures increase the risk of food-borne, water-borne, and vector-borne diseases in humans and animals; high levels of mercury and persistent organic pollutants harm reproductive health in humans and other mammals	Development of One Health strategy: comprehensive understanding of the interconnected and synergistic impacts of environmental pollutants and pathogens
13		USA: Alaska, rural communities [56]	[55] American Indian/Alaska Native population	2020–2021	Heightened vulnerability to the transmission of infectious diseases due to insufficient water and sanitation facilities	Enhanced water and sanitation systems; installation of indoor plumbing infrastructure; establishment of suitable community amenities; provision of adequate healthcare services; offering appropriate financial assistance
14		Canada: Arctic regions [57]	Inuit	1991–2020	Exacerbation of the proliferation, frequency, and severity of enteric pathogen outbreaks	Recognition of signs and symptoms of common and emerging pathogens; updates on antimicrobial trends to determine optimal treatment approaches; implementation of practices to ensure public awareness; detection of emerging pathogens; strengthening surveillance efforts for monitoring trends
15		Russia: Salekhard [58]	Nenets	2016, July	Abnormally high temperatures led to the anthrax outbreak	The last recorded occurrence of the Siberian plague was in 1941
16		Greenland, Iceland, Norway, Sweden, Finland, parts of northern Russia [59]	Entire population	1995–2015	Notable correlations between borreliosis, leptospirosis, tick-borne encephalitis, Puumala virus infection, cryptosporidiosis, and Q fever with climate factors associated with temperature and precipitation	Data-based support for simplified empirical evaluations of the risks posed by various infectious diseases
17		Arctic regions [60]	Entire population	1996–2004	Increase in temperature-sensitive food-borne illnesses (gastroenteritis, paralytic shellfish poisoning, botulism); effect on zoonotic diseases by altering the population and distribution of animal hosts and insect vectors; increased instances of flooding trigger outbreaks of water-borne infections and influence arthropod vectors, as well as the prevalence and northern expansion of vector-borne diseases like West Nile virus	Enhancing public health systems; coordinating disease surveillance with climate monitoring; conducting research on the detection, prevention, control, and treatment of temperature-sensitive infectious diseases
18		Arctic regions [61]	Entire population	1996–2014	Potentially climate-sensitive zoonotic pathogens exhibit sensitivity to climate variations, with their emergence in specific regions	One Health concept: monitoring climate-sensitive infectious diseases, establishing baseline infection levels through seroprevalence surveys in humans and animals, and surveying available specimen banks; assessing disease vectors; research on weather–climate–disease relationships; developing communication strategies to engage Indigenous communities and relevant organizations; collaboration between health, veterinary, and environmental sectors
19		Canada: Arctic regions [62]	Entire population	1969–2022	Northward movement of California serogroup viruses, hosts, and vectors; bite rate escalates as breeding site availability increases, phenological synchronization between the reproductive cycles of hypothesized reservoirs (caribou calving) and mosquito emergence	Engaging in traditional and cultural activities, including outdoor pursuits during peak mosquito activity in summer; preventive measures to minimize the risk of insect bites; public health messages promoting use of effective insect repellents, and wearing long clothing to prevent bites
20		Russia: Komi Republic [63]	Entire population, including Indigenous peoples: Khanty, Mansi, and Nenets	1970–2011	Northward migration of Ixodes persulcatus and tick-borne encephalitis	The emergence of tick-borne encephalitis cases in previously unaffected regions underscores the necessity of revising preventive measures
21		Russia, Canada: Arctic regions [64]	Entire population	2012–2018	Rising temperatures and increased precipitation significantly influence infectious diseases, such as tick-borne diseases, tularemia, anthrax, and vibriosis	Enhanced prevention, vaccination, and educational efforts; comprehensive monitoring and data collection; introduction of One Health approach
22	Mental health	Circumpolar North [65]	Indigenous Peoples	2010–2020	Impacts on mental health exacerbated by shifts in culture and identity, concerns about food security, interpersonal stress and conflicts, housing issues	Development of locally adapted strategies, reinforcing cultural activities, monitoring environmental changes, integrating technologies
23		Canada: Labrador, five communities in Nunatsiavut [66]	Inuit	2012–2013	Weather effect on mental well-being: (1) influencing daily experiences; (2) temporarily altering mood and emotions; (3) seasonally impacting individual and community health and well-being	Conducting culturally specific and location-based investigations; deeper involvement with the real-life impacts of climate on individuals
24		Canada: Labrador, five communities in Nunatsiavut [67]	Inuit	2012–2018	Mental health-related visits: 2.4% of all visits to community clinics; incidence rate increased after two weeks of warmer temperatures (above –5 °C) compared to <–5 °C (incidence rate ratio [IRR]–5 ≤ 5 °C = 1.47, 95% CI = 1.21–1.78; IRR6 ≤ 15 °C = 2.24, 95% CI = 1.66–3.03; IRR > 15 °C = 1.73, 95% CI = 1.02–2.94); the incidence rate decreased with an increase in the number of consecutive days within –5 to 5 °C (IRR = 0.96; 95% CI = 0.94–0.99)	Place-based strategies for health policy, planning, and adaptation to alleviate physical and emotional burdens on individuals, families, communities, and entire populations; investigation of the physiological processes that connect temperature to health issues
25		Canada: Labrador, Rigolet, Nunatsiavut [68]	Inuit	2010	Alterations in weather patterns, stability, and coverage of snow and ice, as well as shifts in wildlife and vegetation distributions linked to climate change, affect mental health: increase family tensions and likelihood of substance abuse, aggravate existing injuries and mental health problems, increase risk of suicidal thoughts	Prioritizing research to underpin adaptation strategies and planning for mental health
26	Extreme temperatures, heat waves, and cold spells	Sweden: Uppsala [69]	Entire population	1915–1929	Risk of stillbirth rose as ambient temperature during pregnancy fell (hazard ratio for a 1 °C decrease in temperature, 1.08; 95% CI = 1.00–1.17); cold extremes adversely affected preterm and birth length; warm extremes increased preterm risk; no relationship between cold and birth weight for gestational age	Explore critical periods influenced by ambient temperature, quantifying the consequences of ambient heat
27		USA: Alaska, Public Health Regions [70]	Entire population	1979–2020	The most significant temporary decrease in the number of hours of extremely cold weather in the Northern Region, reaching up to 13% from 1980–1989 to 2010–2019; annual hours of Universal Thermal Climate Index in the coldest thermal stress categories below 3300 h, >2–3 times higher than in the Interior (1500) and the Southwest (1060)	Develop targeted educational programs integrating Indigenous knowledge for cold weather preparedness; establish collaborative knowledge exchange platforms; enhance infrastructure resilience; implement community-based early warning systems; foster community support networks; mitigate frostbite risk, avoid prolonged exposure, wear warm clothing, and stay indoors when possible
28		USA: Alaska, Anchorage, Fairbanks, Matanuska-Susitna Valley [71]	Entire population	2015–2019, June–Augus	Increased risk of heat illness and cardio-respiratory health effects at threshold Heat Index = 21.1 °C; for people 15–65 y at 21.1 °C (70°F); for children <15 y at 25.6 °C (78°F)	Collaboration between meteorological agencies and local health authorities to establish a heat–health warning system and public awareness materials; weatherization programs to reduce energy consumption and utility expenses
29		Finland: Helsinki [72]	Entire population	2002–2017, June–August	Rising daily temperatures are linked to reduced cumulative risk of sick leaves and short sick leaves over a 21-day lag period; heatwaves are associated with a decreased cumulative risk of sick leaves (relative risk = 0.87, 95% CI = 0.78–0.97) compared to all other summer days (relative risk = 0.83, 95% CI = 0.70–0.98)	High summertime temperatures have protective effects on the health of the working population, likely due to the relatively low summertime temperatures
30		Russia: Yakutsk [73]	Entire population ≥30 y	1999–2007	The mortality rate from coronary heart disease surged by over two-fold during heat and cold waves, while non-accidental mortality rose by around 50%; 8–14 day time lag between the temperature waves and rise in mortality	Predictions of temperature waves can notify public health authorities to anticipate increased mortality rates and to proactively plan emergency health protection measures at least two weeks in advance
31		Russia: Murmansk, Arkhangelsk, Yakutsk [74]	Entire population	1999–2016	Cardiovascular mortality accounted for the heightened total mortality during prolonged exposure to extreme heat and cold	Develop and implement early warning systems for the onset of temperature waves; preventive measures (individual and population-based) to protect the population during extreme heat and cold waves
32		Russia: St. Petersburg, Murmansk, Arkhangelsk [75]	Entire population ≥30 y	1999–2016	Increased cardiovascular mortality during prolonged exposure to extreme heat and cold; during cold spells, Wind Chill Index is a good indicator (compared to ambient air temperature) for explaining variations in daily mortality	Develop action plans with regard to local challenges: climatic (frequency of heat and cold temperature waves, etc.), socioeconomic and demographic situation
33		Russia: Murmansk, Archangelsk, Magadan, Yakutsk [76]	Entire population ≥30 y	1999–2019	Mortality from ischemic heart disease, all circulatory system diseases, and all non-accidental causes among individuals aged ≥65 y during cold spells: relative risk = 1.20 (95% CI = 1.11–1.29), 1.14 (1.08–1.20), and 1.12 (1.07–1.17), respectively; in Murmansk, Archangelsk, and Magadan cold spells are more detrimental compared to heat waves; in Yakutsk, heat waves posed a greater risk	Develop recommendations for evidence-based adaptation planning aimed at mitigating excess deaths during cold spells and heatwaves among vulnerable populations; establishing telephone hotlines or organizing volunteer assistance for elderly residents
34		Finland: Helsinki [77]	Entire population ≥18 y	1997–2018	Cold weather and out-of-hospital cardiac arrest are linked throughout the year; each additional cold day raises their likelihood by 7% (95% CI = 4–10%); in autumn (6%; 95% CI = 0–12%), winter (6%; 95% CI = 1–12%), spring (8%; 95% CI = 2–14%), summer (7%; 95% CI = 0–15%)	Early warning systems and cold weather plans for reducing excess cold-related mortality should be implemented during the whole year
35		Finland: Helsinki Metropolital Area [78]	Entire population ≥18 y	2001–2017, June–August	Increased daily temperatures result in reduced risk of respiratory hospital admissions and asthma; heat waves: 20.5% increase (95% CI = 6.9–35.9); extended or intense heatwaves: increased pneumonia admissions for individuals aged ≥75; heatwaves: increased hospital admissions for myocardial infarction and cerebrovascular diseases; during heatwaves, risk of arrhythmia admissions decreased by 20.8% (95% CI = 8.0–31.8)	Adaptation plans: short-term initiatives target socially deprived or homeless individuals; general population receives information about cold protection via national public broadcasts; key long-term strategies involve enhancing housing insulation and heating systems
36		Russia: Arkhangelsk [79]	Entire population ≥30 y	1999–2008	A total of 289 additional deaths (1999–2008) attributed to the impact of heat waves and cold spells (95% CI = 220–360); relative increases in mortality: heat waves—strokes, non-accidental deaths in the age group ≥65, deaths from external causes in the age groups 30–64 and ≥65); cold spells—coronary diseases, all non-accidental deaths in the age groups 30–64 and ≥65, strokes in the age group ≥65, deaths from external causes in the age group 30–64	Reducing climate-sensitive mortality should become one of the priorities of local governments
37		Canada, Denmark, Finland, Iceland, Norway, Sweden, Russia, USA: 27 Arctic regions [80]	Entire population	1961–1990, January and July	Mean temperature in January is inversely related to infant and perinatal mortality, age-standardized mortality from respiratory diseases, and age-specific fertility for teenagers; for every 10 °C rise in the mean temperature in January, the life expectancy at birth among males increased by approximately 6 years, the infant mortality rate decreased ~4 deaths per 1000 live births; mean temperature in July correlates with infant mortality, mortality from respiratory diseases, and the total fertility	Cold climates are significantly linked to higher mortality and fertility rates in Arctic populations and warrant acknowledgment in national public health planning efforts and cold health risk management
38	Wildfires and air pollution	USA: Alaska [81]	Entire population	2001–2015	Over 15 years, 88% of rural communities experience at least one day with air quality rated as “unhealthy” or worse; half of these communities have air quality conditions exceeding the state average for high PM2.5	Effective mitigation efforts and adaptive measures can be developed by understanding the spatial and temporal patterns of wildfire impact and its effects on human health
39		USA: Alaska, Anchorage and the Kenai Peninsula [82]	Entire population	2019	Immediate and enduring mental health issues: anxiety due to uncertainty, prolonged stress from fires, feelings of loss, a sense of confinement, and heightened substance use; perceived inadequacies in communication from authorities	Improving access to health care, enhancing shelters; providing debriefing during evacuations, prioritizing mental health support for communities, professionals, and responders; tailoring responses to local contexts is crucial due to nuanced mental health challenges
40		Russia: Republic of Sakha (Yakutia), Sebyan-Kyuyol community [83]	Lamunkhinsky Evens people	2021	Wildfires: increased air pollution; permafrost thawing in proximity to communities inflicts substantial harm on infrastructure, human lives and livelihoods; triggers land subsidence, localized flooding, and the creation of lakes and wetlands	Develop strategies and plans adapted to different communities, based on the concept of fire adaptation “pathways”; document perception of wildfire risks, using this information to map areas prone to fire spread
41		Russia: Republic of Sakha (Yakutia) [84]	Indigenous peoples	2010–2021	Aggravation of respiratory diseases, eye complications	Increasing funding for fire protection; training forest protection personnel; enhancing social responsibility of “bottom-up” approach—from private households and local communities up to municipal and governmental levels
42	Permafrost degradation	Russia: North-East, Lorino community [85]	Chukotka Indigenous peoples	2014–2019	By 2050, the depth of seasonal thawing of the soil above the storage facility is projected to increase from 1.12–1.74 to 1.19–2.53 m; significant (albeit non-critical) alterations in the thermal condition of the permafrost surrounding the ice cellar	Maintaining current underground storage and considering new facilities can decrease energy reliance and address food shortages in remote settlements
43		Russia: permafrost regions [86]	Entire population	1960–2019, June–August	Thawing of infected animal carcasses spreading diseases and causing toxic waste seepage containing mercury that transforms into methylmercury in rivers and fish populations; damage to infrastructure like building basements and water systems; worsened living conditions; potential closure of medical facilities, limited access to healthcare, longer patient wait times; increase in infectious diseases	Assessing the costs of restoring infrastructure in various economic sectors affected by permafrost degradation
44		Russia: Yamal-Nenets Autonomous District [87]	Entire population, including Nenets, Komi, Selkups, and Khanty Indigenous peoples	2000–2019	Damaging road infrastructure and healthcare facilities; limiting medical access; increasing infectious disease outbreaks	Supporting indigenous nature management, targeting high-risk demographics like those <30 and men >65, focusing on cardiovascular disease prevention, implementing remote healthcare services and mobile medical teams, monitoring microbial contamination in frozen soil and water sources, and prioritizing low-rise construction to mitigate climate-related infrastructure risks
45		Canada: Indigenous community in the Northwest Territories [88]	Inuit	2019–2020	Health concerns; disruptions to traditional ways of life; infrastructure challenges	Collaboration between scientific, administrative, and community stakeholders; involvement of local citizens in strategic planning; adopting a holistic One Health approach; integrating cultural resilience and intergenerational perspectives; capacity-building for equitable participation and cooperation with Indigenous peoples, leveraging local expertise regarding scientific knowledge
46		Russia: Chukotka; USA: Alaska, 13 Indigenous communities [89]	Chukchi, Iñupiat, and Yupik peoples	2008–2016	Traditional cellars face threats from climate change, relocation, and industrial expansion; despite this, they remain vital for aging and fermenting food	Experimenting with various methods, like adding more ice and snow, deeper excavations, and multiple insulated entrances
47	Food and water security	Russia: Arctic zone of Western Siberia, Yamal [90]	Nenets, Khanty, Selkups and Komi-Zyryans	2012–2018	One-third of the population consumes reindeer products once or twice daily, which is 50% less than previously for both Indigenous and non-Indigenous peoples	Collaborative efforts to address climate change’s adverse impacts without overshadowing Indigenous concerns
48		Russia: Arctic zone of Western Siberia, Yamal [91]	Nenets, Khanty, Selkups and Komi-Zyryans	2012, 2014–2019, 2022	Limited access to high-quality drinking water; significant health risks due to contamination of river water with heavy metals: lead, cadmium, manganese, and iron; consumption of lake ice melt water affects health due to low concentrations of beneficial ions	Enhance water monitoring; improve sanitation and water purification to control health issues, especially heavy metal concentrations; strengthen health monitoring, including analyzing elemental status; control pollution due to oil and gas exploitation on snow cover near reindeer herding routes; implement improved water preparation methods, such as mobile purification installations and magnesium-enriched filters; educational campaigns on securing sustainable, clean water sources and proper use of filtration systems in remote settlements
49		USA: Alaska, Indigenous communities in Interior and coastal regions [92]	Gwitch’in Athabascan Indian and Iñupiat peoples	2015?	Reduction in the availability of subsistence resources caused by climate-related challenges; changes in harvester access, subsistence resource distribution	Indigenous communities successfully sustain harvest practices by exhibiting flexibility in strategies; exploring different harvest times and modes of access
50		Russia: Arctic regions [93]	Entire population, including Indigenous peoples	2000–2011	Shortage of high-quality water, increasing widespread gastroenteritis outbreaks, including Hepatitis A	Preventive actions: enhancing the sanitation standards in urban areas and settlements; upgrading water supply and sewage systems; ensuring the provision and monitoring of drinking water quality; reforming the overall healthcare system; implementing gender-specific epidemiological surveillance; enhancing laboratory diagnostics
51		Canada: Igloolik, Nunavut [94]	Inuit	2006	Extreme climate-related conditions in 2006 affected food security; relationship between climatic conditions and food security outcomes is seldom straightforward, being influenced by multifaceted interactions among various stressors	Individuals reliant on traditional foods and facing economic constraints are especially susceptible; interactions are shaped by factors operating across different spatial and temporal scales
52		Canada: Nunatsiavut, Indigenous communities [95]	Inuit	2005–2008	Climate change alters precipitation patterns (intensity, frequency, and duration), potentially elevating the risk of water-borne diseases: significant positive correlations between elevated water (two and four week lag periods) and clinic visits related to gastrointestinal illnesses	Better understanding and monitoring of local environment–health connections fosters locally tailored, culturally acceptable, and sustainable solutions, helping communities in regards to preparing, adapting, and building resilience
53		USA: Western Alaska, Indigenous communities: Nome, Bethel, Dillingham [96]	Entire population, including Alaska Natives	2019–2020	Top challenges in water systems: power outages, physical threats to infrastructure, wastewater overflows, inflow, and infiltration are associated with extremely cold events, coastal inundation and storm surge, inland flooding, high-speed wind events, permafrost thawing	Adaptation actions at various levels (local to national): information sharing, education, data collection, monitoring, research; expanding capacity, protecting equipment, improving monitoring, assessing vulnerabilities; urban water management focusing on planning, operating, monitoring systems; introducing efficient technologies to enhance resilience; vulnerability assessments, raising climate change awareness, supporting research, adjusting standards, investing in technology
54		Canada: Nunavik, 14 coastal communities [97]	Inuit	2003–2004	The heightened risk of gastroenteric diseases	Adaptation plans: setting up a suitable environmental monitoring system; enhancing wastewater management and municipal water infrastructure; engaging nursing personnel in microbiological water testing at community sites; increasing public awareness regarding the hazards associated with consuming untreated water; collecting strategic health data during peak periods of gastroenteric diseases to explore potential correlations between these ailments and water quality
55		USA: northwest Alaska, coastal community of Kivalina [98]	Inupiat	2003–2009	Erosion and storm surges damage public facilities, leading to closures; melting permafrost causes tundra pond drainage, impacting water sources; rising sea levels threaten drinking water wells with saltwater intrusion; above-ground water and sewer lines face disruption from permafrost melting	Priority interventions: infrastructure development; expanded healthcare services; preventive measures such as water fluoridation; educational initiatives; immunization programs
56		Canada: Indigenous communities in Slave River Delta region of the Northwest Territories [99]	Inuit, AkaitchoDene (First Nations) or Métis in Fort Resolution	2013?	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

, organized based on the climate change risks to human health. In Table 2, the “study population” was defined as the “entire population” in several studies [51,52,53,59,60,61,62,64,69,70,71,72,73,74,75,76,77,78,79,80,81,82,86], and/or as Indigenous peoples or specific Indigenous groups, as described in the papers. The most frequently mentioned group is the Inuit people in Canada [44,46,48,54,57,66,67,68,88,94,95,97,99]. Other groups include the Sámi in Norway [47], the Khanty, Mansi, Nenets, Selkups, and Komi-Zyryans in the Russian North [58,63,90,91], and the Evens people in Russian Sakha (Yakutia) [83]. Studies in Alaska focused on Alaska Native or Indigenous people [56,96]. For example, N. Kettle et al. conducted a study in villages along the Chukchi and Bering Seas in western Alaska, predominantly inhabited by Alaska Natives [96, p. 1516], without specifying particular Indigenous peoples. Three papers from Alaska mention specific groups: Inupiat Eskimos [45], Chukchi, Iñupiat, and Yupik [89], as well as Gwich’in Athabascan Indian and Iñupiat peoples [92]. In some papers, certain age groups were identified, i.e., those 18 years and older [77,78] or those 30 years and older [73,75,76,79].

The “timeline” (study period) was determined according to the research design mentioned in the paper, or based on the publication year of the studies included, if they were review papers. In some instances, the year of the study was not identified, so we used the year preceding the paper’s submission date [92,99]. Most papers cover the period from 1999 to 2023 [44,45,46,47,48,49,50,52,56,73,74,76,81,82,83,84,85,87,88,89,90,91,93,94,95,96,97,98], with specific months or seasons noted in some cases [58,71,72,78,80,86]. There are also retrospective studies, such as the analysis of the relationship between cold temperatures and pregnancy outcomes in Sweden from 1915 to 1929, based on the Uppsala Birth Cohort Study [69], or a study spanning 27 Arctic regions in Canada, Denmark, Finland, Iceland, Norway, Sweden, Russia, and the USA for the period of 1961 to 1990 [80].

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.

4. 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.

4.1. 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].

4.2. 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.

4.3. 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 temperature-sensitive 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].

4.4. 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 community-driven 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].

4.5. 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 social-ecological 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 sectoral-specific 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].

5. 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.

6. 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.

7. 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 well-being 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 knowledge-sharing 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.