Community resilience to the health and wellbeing impacts of environmental and climate change: a review

Abstract Background
Several frameworks and assessment tools exist to understand and evaluate community resilience to climate change and disasters. Yet limited research explicitly measures community resilience to health risks of a changing environment. This review aimed to identify and assess the dimensions and indicators of community resilience frameworks for the health and wellbeing impacts of environmental and climate change. 

Methods
Electronic databases (PubMed, Scopus and Web of Science), grey literature, and reference lists of included studies were systematically searched and screened using inclusion/exclusion criteria at the title and abstract level and then full-text, according to the PRISMA Guidelines. Charted data was analysed using qualitative and quantitative synthesis methods, with dimensions and indicators coded and re-categorised to identify core resilience components and their co-occurrence. 
 
Findings
Across the 8,243 studies screened, 11 unique dimensions and 41 indicator categories of community resilience were identified. The most common dimensions were economic, community capacity, social, and institutional and political dimensions, with no frameworks including both health and environmental dimensions. Consensus on how to measure common dimensions was lacking and many of the indicators required for a comprehensive assessment of health-related community resilience were inconsistently or infrequently employed. Overall, the capacity of the frameworks to account for socially differentiated impacts across a community, as well as factors relating to health and wellbeing, culture, communication and information, and knowledge, attitudes, and behavioural practices, was insufficient.

Interpretation
Findings highlight the need for further studies focused explicitly on health impacts and hazards to establish greater consensus on core dimensions and indicators, including under-represented components and their interconnections. This review makes a strong case that community resilience frameworks for the health impacts of climate change will require greater integration of environmental and health dimensions; factors that more accurately reflect public health interests and dynamics; and equity considerations for unique place-based contexts.