title: Developing rural community health risk assessments for climate change: a Tasmanian pilot study.
abstract: BACKGROUND
  This article examines the development and pilot implementation of an approach to support local community decision-makers to plan health adaptation responses to climate change. The approach involves health and wellbeing risk assessment supported through the use of an electronic tool. While climate change is a major foreseeable public health threat, the extent to which health services are prepared for, or able to adequately respond to, climate change impact-related risks remains unclear. Building health decision-support mechanisms in order to involve and empower local stakeholders to help create the basis for agreement on these adaptive actions is an important first step. The primary research question was 'What can be learned from pilot implementation of a community health and well-being risk assessment (CHWRA) information technology-based tool designed to support understanding of, and decision-making on, local community challenges and opportunities associated with health risks posed by climate change?
  
  
  METHODS
  The article examines the complexity of climate change science to adaptation translational processes, with reference to existing research literature on community development. This is done in the context of addressing human health risks for rural and remote communities in Tasmania, Australia. This process is further examined through the pilot implementation of an electronic tool designed to support the translation of physically based climate change impact information into community-level assessments of health risks and adaptation priorities. The procedural and technical nature of the CHWRA tool is described, and the implications of the data gathered from stakeholder workshops held at three rural Tasmanian local government sites are considered and discussed.
  
  
  RESULTS
  Bushfire, depression and waterborne diseases were identified by community stakeholders as being potentially 'catastrophic' health effects 'likely' to 'almost certain' to occur at one or more Tasmanian rural sites - based on an Intergovernmental Panel on Climate Change style of assessment. Consensus statements from stakeholders also suggested concern with health sector adaptation capacity and community resilience, and what community stakeholders defined as 'last straw' climate effects in already stressed communities. Preventative action and community engagement were also seen as important, especially with regard to managing the ways that climate change can multiply socioeconomic and health outcome inequality. Above all, stakeholder responses emphasised the importance of an applied, complexity-oriented understanding of how climate and climate change impacts affect local communities and local services to compromise the overall quality of human health in these communities.
  
  
  CONCLUSIONS
  Complex community-level assessments about climate change and related health risks and responses can be captured electronically in ways that offer potentially actionable information about priorities for health sector adaptation, as a first step in planning. What is valuable about these community judgements is the creation of shared values and commitments. Future iteration of the IT tool could include decision-support modules to support best practice health sector adaptation scenarios, providing participants with opportunities to develop their know-how about health sector adaptation to climate change. If managed carefully, such tools could work within a balanced portfolio of measures to help reduce the rising health burden from climate change.
authors.affiliation: Wicking Dementia Research and Education Centre, UTAS, Hobart, Tasmania, Australia. erica.bell@utas.edu.au.
authors.forename: Erica J
authors.initials: EJ
authors.lastname: Bell
authors.affiliation: School of Computing and Information Systems, University of Tasmania, Hobart, Tasmania, Australia. paul.turner@utas.edu.au.
authors.forename: Paul
authors.initials: P
authors.lastname: Turner
authors.affiliation: Tasmanian Institute of Agriculture, University of Tasmania, Hobart, Tasmania, Australia. holger.meinke@utas.edu.au.
authors.forename: Holger
authors.initials: H
authors.lastname: Meinke
authors.affiliation: Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, Tasmania, Australia. neil.holbrook@utas.edu.au.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Holbrook
mesh_terms: D057231:Climate Change; D004189:Disaster Planning / Q000458:organization & administration*; D062489:Health Impact Assessment; D006801:Humans; D010865:Pilot Projects; D012423:Rural Health; D019035:Rural Health Services / Q000458:organization & administration*; D013648:Tasmania
keywords: Community Participation; Education; Qualitative Research