text:
Autonomous Motivation Is Not Enough: The Role of Compensatory Health Beliefs for the Readiness to Change Stair and Elevator Use
Health Risk Assessment of Inhalable Particulate Matter in Beijing Based on the Thermal Environment
IJERPH
Boeckmann, M.
Zeeb, H.
Using a Social Justice and Health Framework to Assess European Climate Change Adaptation Strategies
Melanie Boeckmann
1,2,* and
Hajo Zeeb
Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstr. 30, 28359 Bremen, Germany
Center for Social Policy Research, University of Bremen, Mary-Somerville-Str. 5, 28359 Bremen, Germany
Int. J. Environ. Res. Public Health 2014, 11(12), 12389-12411; https://doi.org/10.3390/ijerph111212389
Received: 1 October 2014 / Revised: 24 November 2014 / Accepted: 25 November 2014 / Published: 28 November 2014
Climate change puts pressure on existing health vulnerabilities through higher frequency of extreme weather events, changes in disease vector distribution or exacerbated air pollution. Climate change adaptation policies may hold potential to reduce societal inequities. We assessed the role of public health and social justice in European climate change adaptation using a three-fold approach: a document analysis, a critical discourse analysis of a subgroup of strategies, and a ranking of strategies against our social justice framework. The ranking approach favored planning that includes various adaptation types, social issues and infrastructure changes. Themes on values identified in the five subgroup documents showed that risks are perceived as contradictory, technology is viewed as savior, responsibilities need to be negotiated, and social justice is advocated by only a few countries. Of 21 strategy documents assessed overall, those from Austria, England and Sweden received the highest scores in the ranking. Our qualitative assessment showed that in European adaptation planning, progress could still be made through community involvement into adaptation decisions, consistent consideration of social and demographic determinants, and a stronger link between infrastructural adaptation and the health sector. Overall, a social justice framework can serve as an evaluation guideline for adaptation policy documents.
Keywords: climate change; climate change adaptation; policy analysis; discourse analysis; social justice; public health; social determinants of health; Europe climate change; climate change adaptation; policy analysis; discourse analysis; social justice; public health; social determinants of health; Europe
1.1. Climate Change May Put Health at Risk
Climate change is a reality and may put human health at risk [1,2,3]. Projected climate change impacts include an increased frequency and intensity of heat waves and other extreme weather events, changes in disease vector and pollen distribution, or exacerbated air pollution [1,4,5]. Adverse health effects of climate change may include injuries and death following storms or floods, heat stroke and cardio-respiratory disease aggravation during extreme temperature events, an increased risk of infections and allergies, and higher skin cancer risks from increased UV exposure [1,5,6]. Governments in Europe thus face the need to prepare for these challenges, as has been supported by the Parma Declaration on Environment and Health in 2010 [7,8,9]. The term climate change adaptation describes measures undertaken to adjust to effects of climate, seeking to reduce harm and seize beneficial opportunities [10].
Adaptation has been described as a decision-making process that relies on effective governance [11]. In line with this definition, adaptation can be viewed as a task for all sectors and is not limited to environmental protection. Among previously identified climate change adaptation approaches, the following have been mentioned as promising for health protection: (1) monitoring and research, (2) consideration of demographic and social determinants, (3) community involvement, (4) early warning systems and emergency plans, (5) cross-sectoral efforts, and 6) infrastructural changes [12,13,14,15,16]. An integrated approach consisting of several of these measures has been described as more likely to protect health, regardless of the type of climate change impact [17,18].
1.2. Why a Social Justice Framework for Assessing European Climate Change Adaptation Strategies?
We assessed a sample of European climate change adaptation strategies with a framework informed by social justice concerns. Climate policy is subject to negotiations among priorities, perception and normative thinking [19]. Human health is but one of the concerns of climate-related policymaking. Yet, from a public health point of view, it seems odd that environmental protection should occur without explicit links to health, as the environment strongly influences health itself [20,21]. In addition, public health research has long been aware of the influence social environments have on human health [22].
Climate change affects human health not only directly but also indirectly through putting pressure on existing inequities and social determinants. Climatic changes have been linked to increased gender inequity [23,24], social disruption and forced cultural "re-inventions" [25]. Human health is doubly affected by climate change, once through direct effects on climate-related injuries and illness, and a second time through changes to socio-economic and cultural determinants of health [26,27]. The term "double exposure" [26] additionally implies that some population groups are twice burdened under a changing climate: first from existing inequities, and additionally through new risks imposed. Viewed through this lens, climate change adaptation becomes a tool with which not only the outcomes of climatic changes can be targeted, but which may assist in addressing social determinants of ill health. As such, climate adaptation may contribute to advancing social justice. Social justice matters because it lies at the heart of public health as a discipline [28], and can contribute to health protection [22].
Social and natural environment are difficult to separate: the complex interaction of factors contributing to health have led to the concept of "ecological public health" [29]. As social and cultural dimensions influence susceptibility to climate change related health effects [25,30,31,32], increased vulnerability to environmental risks as a consequence of climatic changes has been framed as an environmental health and justice issue [33,34,35,36].
An assessment of European climate change adaptation can profit from contrasting strategies against a social justice framework that is based on the understanding that:
Unequally distributed social determinants of health create a situation of inequity among European populations [22];
Climate change will exacerbate existing health risks [5];
Adaptation aims to prevent negative impacts of climate change [37], and
Adaptation measures can support health equity through targeting these social determinants of health.
As the official European climate change adaptation strategy also explicitly calls for the integration of social factors into adaptation activities [38], we consider a social justice framework an appropriate and useful concept to assess current European adaptation efforts.
The aim of our study was to assess the health protection potential of selected European climate change adaptation strategies from a critical policy appraisal perspective. Our approach was three-fold: a document analysis on recognized impacts and supported adaptation types of all 21 included strategy papers, a critical discourse analysis identifying themes on value statements of a subgroup of six strategies selected for their inclusion of social justice concerns during a keyword search selection process, and finally a ranking exercise of strategies within a health-focused social justice framework.
2.1. Document Analysis
A narrative review and document analysis of 21 European national adaptation strategies from 19 countries was conducted. We reviewed national adaptation strategies as specified on the European Environmental Agency (EEA) and European Commission (EC) joint website CLIMATE-ADAPT [39], complemented by an online search. The climate-adapt database is a useful source, because the European Environmental Agency aims at providing a comprehensive overview over all member states' strategy approaches and has been included in the European Climate Change Adaptation Strategy [38]. To inquire about draft strategies published in English, we contacted countries with an adaptation strategy under development. The website CLIMATE-ADAPT lists 18 of 32 European countries with an adopted national adaptation strategy as of August 2014 [39]. These countries are Austria [40], Belgium [41], Denmark [42], Finland [43], France [44], Germany [45], Hungary [46], Ireland [47], Lithuania [48], the Netherlands [49], Portugal, Spain [50], Sweden [51], Switzerland [52], Turkey [53], and the United Kingdom [54,55,56]. Within the United Kingdom, Wales [54], Scotland [55] and England [56] provided individual strategies. The online search retrieved the Czech Republic's national adaptation strategy [57] and a Norwegian report [58] on climate change adaptation. Slovakia only provided a background document via personal communication as the official strategy is still being developed. The Bank of Greece provided a general report on impacts and adaptation measures [59].
Eight country strategy documents had to be excluded from analysis: Slovenia's strategy document covers only the forest and agriculture sector. Estonia, Latvia and Italy are currently developing national strategies. Romania, Poland, Bulgaria and Portugal did not provide an English-language version of their strategies and had to be excluded from analysis. Figure 1 shows a map of the countries included in our assessment [60].
Figure 1. Map of European countries included in the study.
Notes: Documents from 19 countries (three from the UK) were included in this study. These countries are marked in dark color. © Eurogeographics [60] for the administrative boundaries.
The search term human health was entered into each adaptation strategy document to assess whether or not adaptation takes place specifically in the health sector. With the aim of covering specific vulnerabilities related to age, migration, socio-economic disadvantages and gender [5,22], the following keywords were used in a second search within documents: social, socio* (* = allowing for all possible endings of the word), justice, fair, disadvantage, elder*, migra* (for migration, migrant, migrate), demograph*, divers* (except biodiversity), and gender. Sampling of strategy documents was driven by two considerations: First, we were interested in the framing of social determinants of climate change vulnerability in the official national document. Thus we excluded all documents that did not touch upon these issues. Second, we included only strategies in the subsample that contained the keywords fairness or justice.
We are aware that an absence carries meanings of its own. However, for the purposes of this research project, these absences of social justice consideration in strategies led to a lower ranking of the strategy and were not analyzed further. Six strategy documents from Austria, England, Finland, Greece, Sweden and Wales were included in our subgroup. The strategy texts were closely read and coded for themes stating values in MaxQDA software using a critical discourse analysis (CDA) approach influenced by van Dijk [61] and Fairclough and Fairclough [62].
2.2. Ranking of Country Strategies against the Social Justice Framework
Our ranking approach is based on adherence to the social justice framework with additional preference for infrastructural adaptation [63].
Bittner et al. [64] proposed a formula for ranking European heat warning systems. They assigned a value between 0 and 2 for stage of development of sub-parts of a heat warning system and added 25% to this partial score in cases where evaluation of the system took place. We propose an altered ranking method that takes into account:
The high relevance of changes in social determinants of health under climate change [65], and
The potential for successful health protection expected from structural adaptation [5].
Thus we argue for a higher weighting of those strategy documents that fare best when situated within the social justice framework. We assigned one point for each type of adaptation included in a national strategy. This is based on comprehensiveness of strategic approaches as our preferred concept for national adaptation efforts [66]. Subsequently, we added percentages to the partial scores as a weighting mechanism: 25% of the partial score for those documents explicitly addressing social justice and fairness (keyword search), 20% of the partial score to those documents addressing migration and demographic changes, two major drivers of structural health inequities [67,68], and 15% of the partial score to those including structural adaptation.
2.3. Critical Discourse Analysis Methodology
The goal of this discourse analysis was to analyze themes surrounding social issues and climate change adaptation that emerged from the texts. What is discourse analysis? It "involves the use of language data as evidence of social phenomena, theorizing language as communication, practice or selective constructions derived from accrued social meanings" ([69], p. 27). The textual data used for this analysis was selected from the pool of all 21 national adaptation strategies in this project as specified above. We first identified six strategy documents that discussed justice and social or cultural aspects of climate change and adaptation through a keyword search. Only documents containing the keywords justice or fairness and additionally migration or demographic changes were included in the subsample. In a second step, topics and value themes in these documents were analyzed following methods proposed by van Dijk [61] and Fairclough and Fairclough [62]. These methods are: close reading of the text, identification of topics and identification of themes related to values through an iterative process of coding, and memoing about these codes.
Fairclough and Fairclough [62] are interested in the power relations that drive the production of texts, using CDA to make conflicts and inequities visible [70]. Wodak and van Dijk stress the importance of context for analysis purposes [61,70]. Context exceeds the text itself and extends into socio-political realms [70]. This understanding makes van Dijk's framework valuable for climate change studies: it has repeatedly been argued that the social context influences vulnerability, resilience and susceptibility to adverse effects of climatic changes [25,71]. Both approaches openly admit to having a political agenda, namely that of exposing mechanisms of social structures and identifying injustices [70].
Critical discourse theorists argue that knowledge can have different versions, some of which are accepted as truths and can be used to advance certain groups over others [69]. According to van Dijk [72], acceptance relies on access to dissemination of knowledge, for instance to media outlets. Official national documents may be perceived as prestigious and result in or prescribe specific actions, thus shaping the future of adaptation in each country. Consequently, exclusion or inclusion of social issues conveys an important message.
"Meanings are constituted through what is done" ([69], p. 10), therefore these documents show meanings attributed to health and social issues in national climate change adaptation strategies through what they suggest is done (as adaptation), and through the language and terms they are using.
Following Van Dijk's approach [61], we searched for topics within texts to identify what a section of text represents, so that the principles behind the strategy documents could be elicited. In a second step, we identified themes revolving around values. Values play an important role in Fairclough and Fairclough's practical reasoning framework [62]. Fairclough and Fairclough describe "practical reasoning [as] reasoning concerning what to do " ([62], p. 35) (emphasis by the authors of this article). As this study aimed to assess climate change adaptation regarding its inclusion of and potential for health protection, the actions outlined in the strategy documents are of high interest. Processes of negotiation in climate change contexts have been discussed elsewhere [73,74] and are not part of this research project.
The document analysis revealed that all strategy documents include comments on health risks of climate change. Human health is a factor in the description of climate change impacts, adaptation options, or both.
3.1. Impacts of Climate Change on Health
Heat and extreme weather events play the largest role in European adaptation strategies, followed by infectious diseases (Figure 2). All 21 documents include heat, and 90% of documents discuss extreme weather events. Vector-, food- or water-borne infections are mentioned in 86% of the documents. Additional climate change impacts on health discussed are changes in aeroallergen distribution and exacerbation of air pollution (57% each), increase in UV radiation exposure (29%), mold development in houses (24%), food security (14%), and mental health issues (10%). Population displacement as results of climatic changes is only discussed in the Irish strategy.
Figure 2. Impacts of climate change on health discussed in strategy documents ranked by frequency of inclusion in strategy documents (more than one impact was mentioned in each document). Heat and extreme weather events were mentioned separately in the texts, as were vectors and other infections. Infections refer to food- and water-borne infections.
3.2. Adaptation Measures in European Strategy Documents
We categorized adaptation into four major types, based on a typology proposed by Balbus et al. [75]:
Data and surveillance
Technological adaptation, including emergency plans and warning systems
Behavioral adaptation and awareness raising
Infrastructural adaptation
When categorized according to type of adaptation, the most frequently cited adaptation type is awareness raising and education programs (18 documents), with technological adaptation and data/surveillance categories in 16 documents each (Figure 3). Infrastructural and engineering adaptation comes in last with 14 documents. Germany, Denmark, Hungary, and Turkey advocate vaccine development for emerging infectious diseases. Lithuania plans to strengthen health sector financing, and the Czech Republic stresses changes in European and national legislation as an additional strategy.
Figure 3. Types of adaptation proposed by strategy documents ranked by most frequent inclusion in strategy documents (more than one adaptation type was mentioned in each document).
Adaptation to health impacts is proposed by all 21 strategy documents. Specificity and comprehensiveness of the proposed adaptation measures vary between the strategies. Slovakia, for instance, focusses on raising awareness among medical personnel and on implementation of a warning system. Turkey, on the other hand, includes all four types of adaptation in its planning. Of interest are innovative, structural adaptation measures proposed by strategies, such as building publicly accessible water fountains in Austria, adding air conditioning to hospitals in Sweden, or strengthening the National Health Service in England. Mainstreaming climate change adaptation into all policies is suggested by Austria.
Impacts such as food security, linked to climate impacts on global agriculture, mold development in private housing, UV radiation exposure, exacerbated air pollution, and mental health impairments after extreme events are mostly excluded from the adaptation descriptions. England suggests public UV monitoring. It is unclear whether this results from prioritization of other health impacts or from difficulties creating an adaptation measure for these risks. These risks in particular require trans-sectoral and societal approaches.
Not all country strategy documents view climate change as a threat: Norway and the Czech Republic position themselves as well-prepared for climate change. Despite a common awareness of climate change impacts and associated health risks, European adaptation programs differ in their assessment of potential consequences of these impacts.
The results of our document analysis show that adaptation measures for highly ranked risks such as extreme weather events, extreme temperatures and infectious diseases are persistently recommended in European national strategies. Beyond these common aims, however, varied levels of comprehensiveness occur between countries. These variations include both additional impacts recognized and adaptation measures proposed. A second variation can be found in the documents' treatment of social issues, as discussed in the following paragraphs.
3.3. Ranking of Country Documents
Table 1 shows the ranking of the examined European national strategies against the social justice framework. The baseline partial score was calculated from number of adaptation types included; the more different types, the more comprehensive we judged the strategy to be. To this partial score we added weighting for social justice. Owing to this approach, Wales, with fewer adaptation types, did not rank in the upper two thirds despite its commitment to promoting fairness and equity.
Country strategies with the highest score are Austria, England and Sweden. These documents not only recommended all four types of adaptation measures but were additionally committed to promoting social justice, taking into account social determinants, and gained extra points for the inclusion of infrastructural adaptation. Six country documents rank in second place. In this ranking, we find Denmark, Lithuania and Scotland with a score below 2.5, followed by Ireland and the Netherlands.
3.4. Discourse Analysis of Subgroup Articles
Results of the CDA are represented as four value themes: (a) the cautionary principle in light of uncertainties, (b) responsibility, (c) technology as savior and (d) social justice and gender equity.
3.4.1. The Cautionary Principle in Light of Uncertainties
Uncertainties are inherent to climate projections and lie at the heart of climate adaptation projects. Certain risks to human health have been described as generally applicable (such as extreme temperature, extreme weather events, and vector distribution changes, see also introduction of this article). Yet this universality of risks is handled differently among the examined countries. Heat to Finland [43] is both a risk and not a risk: a contradiction. Compare the following statements as an example:
"Excess mortality is significantly higher in extremely cold temperatures than during periods of intense heat, and extremely cold temperatures are estimated to become less common,"
([43], p. 157)
"[…][H]ealth impacts due to hot weather can be expected at lower temperatures in Finland compared to Central Europe".
Here we observe an ambiguity in confronting an increase in extreme heat events.
Table 1. Ranking results.
Type of Adaptation
Partial Score
Social Issues Migration and Demographic Change
Structural Adaptation
Data/Surveillance
Add 25%
Austria 1 1 1 1 4 1 0.8 0.6 6.4
UK: England 1 1 1 1 4 1 0.8 0.6 6.4
Sweden 1 1 1 1 4 1 0.8 0.6 6.4
Belgium 1 1 1 1 4 0 0.8 0.6 5.4
Czech Republic 1 1 1 1 4 0 0.8 0.6 5.4
France 1 1 1 1 4 0 0.8 0.6 5.4
Germany 1 1 1 1 4 0 0.8 0.6 5.4
Norway 1 1 1 1 4 0 0.8 0.6 5.4
Turkey 1 1 1 1 4 0 0.8 0.6 5.4
Finland 1 1 0 1 3 0.75 0.6 0.45 4.8
Greece 1 1 0 1 3 0.75 0.6 0.45 4.8
Hungary 0 1 1 1 3 0 0.6 0.45 4.05
Switzerland 1 0 1 1 3 0 0.6 0.45 4.05
Slovakia 0 1 1 1 3 0 0 0.45 3.45
Spain 1 1 1 0 3 0 0 0 3
UK: Wales 0 1 1 0 2 0.5 0.4 0 2.9
Denmark 1 0 1 0 2 0 0.4 0 2.4
Lithuania 1 0 1 0 2 0 0.4 0 2.4
UK:Scotland 1 0 1 0 2 0 0.4 0 2.4
Ireland 0 1 1 0 2 0 0 0 2
Netherlands 0 0 0 0 0 0 0 0 0
A similar debate occurs regarding vector-borne diseases: On the one hand:
"the climate has not been decisive for the occurrence of these communicable diseases or the emergence of a pathogen cycle,",
([43], pp. 158–159)
yet at the same time the Finish strategy suggest that ticks or bank voles may find more favorable conditions as a result of climate change ([43], p. 160).
These findings suggest that that careful consideration is of high value in Finland, with the goal of targeting the right risks. Overall, the contradictory nature of temperature-related risks does not deter Finland from acting: we would call this an adherence to the precautionary principle. This is illustrated in the following statement on reviews as part of an adaptation strategy:
"[these are] the foundation for evaluating any no-regrets measures whose implementation would benefit the sector or target groups regardless of climate change".
([43], p. 11)
Benefits regardless of climate change as the ultimate justification for adaptation fits well into a precautionary framework.
This theme has also been picked up by Sweden [51]:
"The warmer climate will affect health and lead to more deaths due to heat waves and increased spread of infection",
later followed by:
"Few cold snaps produce positive health effects".
Acknowledging uncertainties leads to precautious activities in climate change adaptation. Policy acts in the face of scientific uncertainties, a theme that may be useful for social justice action among the lines of "better safe than sorry".
3.4.2. Who is Responsible for Adaptation?
A second theme prominent in the examined documents is global responsibility. European countries highlight contrasts between their positions and those of countries of the Global South, and formulate consequences of that positioning. For instance, Sweden [51] argues from a legal standpoint:
"According to article 4.4 of the Climate Convention (UNFCCC), the industrialised countries (Annex I countries) should support the developing countries that are most vulnerable to climate change".
Wales [54] takes this theme further and acknowledges that as an industrialized country in the Global North:
"we are responsible for a much larger proportion of global emissions because of the goods and services we consume but which are made elsewhere".
As a consequence, Wales proposes that:
"Sharing experience and learning on this challenging agenda is vital and we are committed, through our Wales for Africa programme, to working with communities in other parts of the world in responding to climate change".
England [56] similarly states that:
"the government continues to support programmes helping the poorest and most vulnerable people in climate change 'hot-spots', as well as identifying and refining tools which are cost-effective and sustainable".
Such commitment to "help" could also be interpreted as "othering" Africa and possibly additional countries in the Global South [76]. By creating a dichotomy of rich versus poor, technologically advanced versus helpless in the face of climate change, these European strategy documents may cement inequities rather than promote social justice. This interpretation is supported by a common perception that immigration is a result of climatic changes. The Austrian strategy states that:
"studies on development mechanisms of migratory movements to Austria and Europe should be initiated to reduce or deal with possible migration"(translated from German by the authors)".
Greece [59] "has already received large numbers of immigrants, and these numbers will increase significantly in future as the flow of environmental refugees increases",
and Sweden [51] concurs:
"Sweden will also experience an increased number of cases of infectious diseases where the infection is contracted overseas due to increased global infection pressure".
Immigration to European countries is discussed in the strategies and represents awareness about global migratory patterns.
The link between poverty and effects of climate change is generally acknowledged, leading to the above mentioned referral to Europe's responsibility to mitigate climate change and support lower income countries. Incorporating environmental agreements into aid and development is Europe's answer to these global inequities. Again, this approach has its shortcomings: within the UNFCCC negotiation processes, the least developed countries need to combine mitigation efforts and related expenses with national development goals [77]. Future research could examine this issue further and assess the implications between causing environmental harm first and subsequentlyoffering the "gift" of support to those being harmed in the process [78].
3.4.3. Technology as Savior
Within the Welsh, English and Finnish strategy documents, technological adaptation is highlighted as the best solution, particularly for flood risks or in the shape of heat warning systems. As a value statement, inherent to technological solutions to climate change is solvency, i.e., being in a financially secure situation.
Finland [43] stresses that:
"development of solvency is crucial to human health", and "[t]he industrial-technical culture […] is capable of protecting human beings in various ways".
England [56] agrees:
"Development and economic progress will, in many cases, be the most effective way of helping countries to adapt, as well as helping to create stability",
and proposes the development of new technology. Wales [54] is particularly ambitious in linking technology and climate change:
"Ensuring that our approach to R&D, technology, innovation and skills help Wales gain maximum benefit from climate change related business and research".
([54], p. 6)
A technocratic solution also links back to the previous theme of responsibility and "othering": while European countries are in the position to afford high-tech alternatives, the majority of countries might not be. A consequence could be a commitment to giving these technologies to the Global South, the implications of which have been discussed above. Beyond adaptation, technology plays an important role for mitigation with its promise of energy efficiency and "a new green deal [56]." In England and Wales, technology in adaptation is thus portrayed as promising economic opportunity, not only as a means to an end. The examined strategies value solvency, technological advancement and co-benefits of adaptation. The Greek document in particular points out financial gains as motivation for adaptation.
3.4.4. Social Justice and Gender Equity
The theme of social justice is intricately linked to antidiscrimination, gender equity, fairness, and protecting cultural diversity. Austria and Wales specifically mention justice as a value and a goal.
Related to the issue of global responsibility, but equally applicable to the national context, Wales [54] acknowledges:
"Climate change is a social justice issue. Globally, and here in Wales, we can expect its impacts to disproportionately affect those least able to manage them and who are, at the same time, least responsible for causing the problem".
A clearly stated goal of the Welsh strategy is to:
"[…] ensure that our policies to tackle climate change also promote social justice".
Similarly, Austria [40] writes that policy development should weigh benefits and harms:
"stratified by different population groups and gender" (translated from German by the authors).
Regarding gender equity, the Austrian document proposes a commitment to enabling women to participate in adaptation processes:
"It is important that even within climate change adaptation measures women receive equal opportunities to participate, create and decide in societal processes"(translated from German by the authors) .
However, neither strategy gives recommendations on specific actions to achieve social justice.
4. Discussion
4.1. Europe is Aware of Climate Change Health Impacts
In general, protecting human health is one goal of European climate change adaptation strategies. The impact assessments are in line with research results on projected impacts of climate change [1]. This is not surprising given that the strategy documents regularly refer to published research.
Our results confirm those of previous studies on human health as a vulnerable sector in national European adaptation strategies [66,79]. However, the link between health protection and climate change adaptation in other sectors is not always explicit. For instance, the Netherlands plans for flood risks, yet their strategy does not discuss health implications of structural adaptation.
Heat warning systems have recently been the subject of increased research activity [16,64], yet the national documents rarely described heat warning systems as specific projects. A possible explanation for this discrepancy may lie in national versus regional climate change adaptation approaches. A second reason might be the distribution of responsibilities between departments. And finally, heat warning systems are concrete outputs of adaptation projects, whereas national strategy documents serve the purpose of outlining a country's overall approach to adaptation, specifying concrete actions in add-on documents. This has been done in Austria, Germany and France, for example, where action plans support the national strategies.
4.2. Social Determinants of Health Play a Role in European Climate Change Adaptation
Consideration of social and demographic determinants has been identified as an important aspect of climate adaptation [80]. In the examined adaptation strategies, social and socio-economic factors were considered in scenario design or impact analysis. Austria, Wales, England and Turkey acknowledged gender as a category that might contribute to (further) inequities. As we have seen in the discourse analysis, responsibility as a theme illustrates awareness of the interconnectedness of European countries with countries in the Global South. The role of social determinants of health is thus not limited to the local but extends beyond European borders. This may influence decision-making processes. It would be interesting to contrast these environmental strategies with official development aid documents and practices to see if values and goals are aligned between sectors. This might also shed light on whether solvency, a highly rated goal in England and Greece, extends to increasing solvency in the Global South. We also find it of interest that the precautionary principle plays such a large role in the discussion about climate change adaptation measures and human protection.
Six European adaptation strategies explicitly address climate change as a social justice issue, and 17 documents show awareness of migration and demographic changes as risk factors of climate change (Table 1). These results might be interpreted as promising; whether actual measures to reduce structural inequities will be taken remains to be seen. The large number of documents including proposals for structural adaptation might bear potential for health protection, as structural disease prevention programs have also been described as effective in environmental health [81]. Our novel ranking approach allowed us to combine assessments of justice and health protection potentials. However, any ranking has an inherent bias towards certain variables: the Czech Republic fared well in the ranking, yet the entire strategy only discusses health in one paragraph. Any ranking results should therefore not replace an in-depth analysis of policy documents before drawing conclusions.
4.3. Weaknesses of European Strategies Persist
Our results show a gap between current knowledge on good practice adaptation for health and specific actions in health policy, confirming previous research [8,66,82]. Not all good practice advice from research has been incorporated into European adaptation design. There seems to be potential for improvement in linking health and infrastructure or planning, especially for the climate risks of flooding and extreme heat as these are highly relevant for urban design and for the health sector. Very little consideration has been given to community involvement. Most national strategies examined here do not yet adequately design approaches for the inclusion of communities or adaptation target populations. Wales is a positive exception, focusing on local adaptation efforts. Overall, further research into appropriate forms of participatory adaptation in Europe seems warranted. Such research designs could draw from results of community-based adaptation projects in developing countries [71,83].
A large number of European strategies are not yet accompanied by action plans, indicating further potential for an improved adaptive response. Systematic considerations of uncertainties associated with climate change adaptation, from climate models to national socio-economic development, are still missing [66]. Uncertainties play a prominent role in climate change discourses: from estimating impacts [84] to evaluating policy [85], what we cannot know about the future shapes current responses to climate change. Living with these uncertainties might require policymakers to rethink standard approaches to evidence-based policy.
Within the policy documents, possible co-harms and co-benefits to health of proposed adaptation strategies are rarely explored. Previous research has suggested that any adaptation measure could lead to unwanted negative effects on health, such as changing walking behavior through urban planning adjustments [86]. Both negative and positive effects of strategic measures could also be modelled, as has been done for mitigation strategies [87].
4.4. What Is Next for European Adaptation Strategies?
Within the climate and health research community, new concepts have been proposed. "Planetary health" [88] stresses the links between global environments and human health. If we assume such a large scale interdependency, strategies that only propose isolated individual adaptation measures might not be sufficient. As stated before, evidence for the effectiveness of specific measures is still missing, despite hints at potential effects of adaptation [89,90]. Instead, viewing adaptation policy as a larger, transformational effort has been suggested [91]. Karen O'Brien distinguishes between unintended and deliberate transformation, and defines it as "[…] physical and/or qualitative changes in form, structure or meaning-making that can also include a psycho-social process" [91]. Applied to European adaptation strategies, transformation could mean trans-sectoral approaches, long-term visions, innovative solutions, and designing policies aimed at structural changes. We have seen that the examined strategies propose technological innovations, "green deals" and even "cultural re-inventions," to borrow the term from Adger et al. [25]. Some ideas of transformational designs are already included in Europe's strategies, yet the term itself is not used.
This study has several limitations. Only national strategies and draft national documents were included in the analysis. Individual cities or regions might have different strategies in place. Local adaptation is likely more capable of taking regional differences and needs into account [92]. However, national legislation plays an important role in encouraging and enabling regional agencies to pursue adaptation [92]. Several European countries are currently developing strategies not yet included in this study. Climate change adaptation is a work in progress, and keeping track of updated documents is challenging.
Documents without an English or German translation had to be excluded. Six of nine strategy documents excluded are from Central and Eastern European countries. Their national adaptation strategies might stress different approaches for health protection not covered here.
Using a social justice framework of course implies our normative approach to climate change adaptation. Our ranking method and selection of themes mirrors this normative understanding and may not necessarily reflect the aims of the policymakers who developed the strategies.
Recent studies have reviewed European heat wave warning systems [16,64], finding a larger number of warning strategies in place than mentioned in official national strategy documents. The reason for this omission in official national documents is unclear.
As we selected the strategies for the discourse analysis based on their discussion of social determinants, we are necessarily biased to detect reasons for an inclusion of said determinants rather than reasons for exclusion. Strategies without social determinants do not state reasons for the omission. We argue that the absence in itself carries a local meaning: it could be interpreted as perceived lack of relevance and/or political will to engage with these social aspects of climate change adaptation. Additionally, our assessment was necessarily based on the data sources we used. Other documents from the selected countries may lead to different conclusions.
A social justice framework can serve as an evaluation guideline for adaptation policy documents. We were able to show that the links between social determinants of health and a potential exacerbation of inequities under climatic changes are partially acknowledged in European countries.
Drawing from previous research into evaluation of adaptation, we have developed a theory-driven method to portray most promising strategy documents for health protection through foregrounding social justice, social determinants of health, and structural adaptation measures. Our results can contribute to strengthening the focus on human health and reduction of injustices in adaptation efforts.
In this article we have repeatedly pointed out the necessity to ground any adaptation actions for health protection in a socially responsible framework.
Our results suggest that European adaptation strategies are aware of climate risks, including adverse effects on health. A large number of European countries have made strides in preparing for climate change and combine two or more adaptation types to address these risks. This study complements a recent WHO survey on health action and climate change in Europe [8] by adding a social justice dimension and qualitative assessment. In European countries, progress could still be made through community involvement into adaptation decisions, and consistent inclusion of social and demographic determinants. A stronger link between infrastructural adaptation and the health sector could be considered.
This study was partially supported by a University of Bremen and Leibniz Institute for Prevention Research and Epidemiology-BIPS joint dissertation scholarship for Melanie Boeckmann. The authors would like to thank Nataliya Makarova and Andrew N. McIntyre for critical readings of the manuscript and helpful comments. Two anonymous reviewers gave helpful suggestions.
Melanie Boeckmann designed the study, conducted the analyses and developed the manuscript. Hajo Zeeb suggested a ranking approach and co-wrote the manuscript. Both authors have read and approved the final version of this manuscript.
Confalonieri, U.; Menne, B.; Akhtar, R.; Ebi, K.L.; Hauengue, M.; Kovats, R.S.; Revich, B.; Woodward, A. Human health. In Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change; Parry, M.L., Canziani, O.F., Palutikof, J.P., van der Linden, P.J., Hanson, C.E., Eds.; Cambridge University Press: Cambridge, UK, 2007; pp. 391–431. [Google Scholar]
Barrett, J.R. Climate change mitigation: Assessing strategies that offer potential human health benefits. Env. Heal. Perspect. 2014, 122. [Google Scholar] [CrossRef]
World Health Organization. Quantitative Risk Assessment of the Effects of Climate Change on Selected Causes of Death, 2030s and 2050s; Hales, S., Kovats, S., Lloyd, S., Campbell-Lendrum, D., Eds.; World Health Organization: Geneva, Switzerland, 2014. [Google Scholar]
Füssel, H.-M. An updated assessment of the risks from climate change based on research published since the IPCC Fourth Assessment Report. Clim. Change 2009, 97, 469–482. [Google Scholar] [CrossRef]
Smith, K.R.; Woodward, A.; Campbell-Lendrum, D.; Chadee, D.; Honda, Y.; Liu, Q.; Olwoch, J.; Revich, B.; Sauerborn, R. Human health: Impacts, adaptation and co-benefits. In Climate Change 2014: Impacts, Adaptation and Vulnerability. Part A: Global and sectoral aspects. Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change; Field, C.B., Barros, V.R., Dokken, D.J., Mach, K.J., Mastrandrea, M.D., Bilir, T.E., Chatterjee, M., Ebi, K.L., Estrada, Y.O., Genova, R.C., et al., Eds.; Cambridge University Press: Cambridge, UK; New York, NY, USA, 2014; pp. 709–754. [Google Scholar]
McMichael, A.; Montgomery, H.; Costello, A. Health risks, present and future, from global climate change. BMJ 2012, 344. [Google Scholar] [CrossRef] [PubMed]
European Evironment Agency (EEA). Urban Adaptation to Climate Change in Europe; EEA Report 2/2012; European Environment Agency: Copenhagen, Denmark, 2012. [Google Scholar]
Wolf, T.; Martinez, G.S.; Cheong, H.-K.; Williams, E.; Menne, B. Protecting health from climate change in the WHO European region. Int. J. Environ. Res. Public Health 2014, 11, 6265–6280. [Google Scholar] [CrossRef] [PubMed]
World Health Organization. Ministerial conference on environment and health parma declaration on environment and health. In Fifth Ministerial Conference on Environment and Health: "Protecting children's health in a changing environment"; World Health Organization Regional Office for Europe: Copenhagen, Denmark, 2010. [Google Scholar]
IPCC. IPCC Annex III: Glossary. In Climate Change 2013: The Physical Science Basis. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change; Stocker, T.F., Qin, D., Plattner, G.-K., Tignor, M., Allen, S.K., Boschung, J., Nauels, A., Xia, Y., Bex, V., Midgley, P.M., Eds.; Cambridge University Press: Cambridge, UK; New York, NY, USA, 2013; pp. 1447–1465. [Google Scholar]
Nelson, D.R.; Adger, W.N.; Brown, K. Adaptation to environmental change: Contributions of a resilience framework. Annu. Rev. Environ. Resour. 2007, 32, 395–419. [Google Scholar] [CrossRef]
Ebi, K.L.; Lindgren, E.; Suk, J.E.; Semenza, J.C. Adaptation to the infectious disease impacts of climate change. Clim. Change 2013, 118, 355–365. [Google Scholar] [CrossRef]
Kovats, R.S.; Kristie, L.E. Heatwaves and public health in Europe. Eur. J. Public Health 2006, 16, 592–599. [Google Scholar] [CrossRef]
Wolf, J.; Adger, W.N.; Lorenzoni, I.; Abrahamson, V.; Raine, R. Social capital, individual responses to heat waves and climate change adaptation: An empirical study of two UK cities. Glob. Environ. Chang. 2010, 20, 44–52. [Google Scholar] [CrossRef]
Semenza, J.C.; Suk, J.E.; Estevez, V.; Ebi, K.L.; Lindgren, E. Mapping climate change vulnerabilities to infectious diseases in Europe. Environ. Health Perspect. 2012, 120, 385–392. [Google Scholar]
Lowe, D.; Ebi, K.L.; Forsberg, B. Heatwave early warning systems and adaptation advice to reduce human health consequences of heatwaves. Int. J. Environ. Res. Public Health 2011, 8, 4623–4648. [Google Scholar] [CrossRef]
Frumkin, H.; Hess, J.; Luber, G.; Malilay, J.; McGeehin, M. Climate change: The public health response. Am. J. Public Health 2008, 98, 435–445. [Google Scholar] [CrossRef]
Costello, A.; Abbas, M.; Allen, A.; Ball, S.; Bell, S.; Bellamy, R.; Friel, S.; Groce, N.; Johnson, A.; Kett, M.; et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet 2009, 373, 1693–1733. [Google Scholar]
Urwin, K.; Jordan, A. Does public policy support or undermine climate change adaptation? Exploring policy interplay across different scales of governance. Glob. Environ. Chang. 2008, 18, 180–191. [Google Scholar]
O'Neill, M.S.; McMichael, A.J.; Schwartz, J.; Wartenberg, D. Poverty, environment, and health: The role of environmental epidemiology and environmental epidemiologists. Epidemiology 2007, 18, 664–668. [Google Scholar] [CrossRef]
Prüss-Üstün, A.; Corvalán, C. Preventing Disease through Healthy Environments. Towards an Estimate of the Environmental Burden of Disease; World Health Organization: Geneva, Switzerland, 2006. [Google Scholar]
Marmot, M.; Allen, J.; Bell, R.; Bloomer, E.; Goldblatt, P. WHO European review of social determinants of health and the health divide. Lancet 2012, 380, 1011–1029. [Google Scholar] [CrossRef]
European Institute for Gender Equality. Gender Equality and Climate Change—Main Findings; Publications Office of the European Union: Brussels, Belgium, 2012. [Google Scholar]
United Nations Development Program. Resource Guide on Gender and Climate Change; United Nations Development Program: New York, NY, USA, 2009. [Google Scholar]
Adger, W.N.; Barnett, J.; Brown, K.; Marshall, N.; O'Brien, K. Cultural dimensions of climate change impacts and adaptation. Nat. Clim. Chang. 2013, 3, 112–117. [Google Scholar]
O#x2019;Brien, K.L.; Leichenko, R.M. Double exposure: Assessing the impacts of climate change within the context of economic globalization. Glob. Environ. Chang. 2000, 10, 221–232. [Google Scholar]
Friel, S.; Hancock, T.; Kjellstrom, T.; McGranahan, G.; Monge, P.; Roy, J. Urban health inequities and the added pressure of climate change: An action-oriented research agenda. J. Urban Health 2011, 88, 886–895. [Google Scholar]
Gostin, L.O.; Powers, M. What does social justice require for the public's health? Public health ethics and policy imperatives. Health Aff. (Millwood) 2006, 25, 1053–1060. [Google Scholar]
Morris, G.P. Ecological public health and climate change policy. Perspect. Public Health 2010, 130, 34–40. [Google Scholar] [CrossRef]
Vescovi, L.; Rebetez, M.; Rong, F. Assessing public health risk due to extremely high temperature events: Climate and social parameters. Clim. Res. 2005, 30, 71–78. [Google Scholar] [CrossRef]
Harlan, S.L.; Declet-Barreto, J.H.; Stefanov, W.L.; Petitti, D.B. Neighborhood effects on heat deaths: Social and environmental predictors of vulnerability in Maricopa County, Arizona. Environ. Health Perspect. 2013, 121, 197–204. [Google Scholar]
Nielsen, J.Ø.; Reenberg, A. Cultural barriers to climate change adaptation: A case study from Northern Burkina Faso. Glob. Environ. Chang. 2010, 20, 142–152. [Google Scholar]
Sovacool, B.K. Adaptation: The complexity of climate justice. Nat. Clim. Chang. 2013, 3, 959–960. [Google Scholar]
Barrett, S. Local level climate justice? Adaptation finance and vulnerability reduction. Glob. Environ. Chang. 2013, 23, 1819–1829. [Google Scholar]
Morello-Frosch, R.; Zuk, M.; Jerrett, M.; Shamasunder, B.; Kyle, A.D. Understanding the cumulative impacts of inequalities in environmental health: Implications for policy. Health Aff. (Millwood) 2011, 30, 879–887. [Google Scholar] [CrossRef]
Bowen, K.J.; Friel, S. Climate change adaptation: Where does global health fit in the agenda? Global. Health 2012, 8. [Google Scholar] [CrossRef]
Adger, W.N.; Arnell, N.; Tompkins, E. Successful adaptation to climate change across scales. Glob. Environ. Chang. A 2005, 15, 77–86. [Google Scholar]
European Commission. An EU Strategy on adaptation to climate change; European Union: Brussels, Belgium, 2013. [Google Scholar]
European Union CLIMATE-ADAPT. European Climate Adaptation Platform. Available online: http://climate-adapt.eea.europa.eu/ (accessed 30 September 2014).
Bundesministerium für Land-und Forstwirtschaft Umwelt und Wasserwirtschaft. Die österreichische Strategie zur Anpassung an den Klimawandel; Government of Austria: Vienna, Austria, 2012. [Google Scholar]
Belgian National Climate Commission. Belgian National Climate Change Adaptation Strategy; Government of Belgium: Brussels, Belgium, 2010. [Google Scholar]
Danish Government. Danish Strategy for Adaptation to a Changing Climate; Government of Denmark: Copenhagen, Denmark, 2008. [Google Scholar]
Ministry of Agriculture and Forestry Finland. Finland's National Strategy for Adaptation to Climate Change; Government of Finland: Helsinki, Finland, 2005. [Google Scholar]
Ministère de l'Écologie du Développement durable des Transports et du Logement. French National Climate Change Impact Adaptation Plan; Government of France: Paris, France, 2011. [Google Scholar]
Federal Ministry for the Environment Nature Conservation and Nuclear Safety. German Strategy for Adaptation to Climate Change; The Federal Government of Germany: Bonn, Germany, 2008. [Google Scholar]
Hungarian Government. National Climate Change Strategy 2008–2025; Government of Hungary: Budapest, Hungary, 2008. [Google Scholar]
Department of the Environment Community and Local Government Ireland. National Climate Change Adaptation Framework Building Resilience to Climate Change; Government of Ireland: Dublin, Ireland, 2012. [Google Scholar]
Government of the Republic of Lithuania. Resolution on the Approval of the National Strategy for the Implementation of the United Nations Framework Convention on Climate Change until 2012; Government of the Republic of Lithuania: Vilnius, Lithuania, 2008. [Google Scholar]
Ministry of Housing, Spatial Planning and the Environment (VROM); Ministry of Transport, Public Works and Water Management (V&W); Ministry of Agriculture, Nature and Food Quality (LNV); Ministry of Economic Affairs (EZ); Association of Provincial Authorities (IPO); Association of Netherlands Municipalities (VNG); Association of Water Boards (UvW). Make Room for the Climate. Initial Steps towards a National Adaptation Strategy; Government of The Netherlands: Den Haag, The Netherlands, 2007.
Ministry of Environment and Rural and Marine Affairs Spain. The Spanish National Climate Change Adaptation Plan; Government of Spain: Madrid, Spain, 2008. [Google Scholar]
Swedish Commission on Climate and Vulnerability. Sweden Facing Climate Change: Threats and Opportunities; Government of Sweden: Stockholm, Sweden, 2007. [Google Scholar]
Bundesamt für Umwelt. Anpassung an den Klimawandel in der Schweiz: Handlungsfelder. Erster Teil der Strategie des Bundesrates; Government of Switzerland: Bern, Switzerland, 2012. [Google Scholar]
T.R. Ministry of Environment and Urbanization. Turkey' s National Climate Change Adaptation Strategy and Action Plan; Government of Turkey: Ankara, Turkey, 2011. [Google Scholar]
Welsh Assembly Government. Climate Change Strategy for Wales; Welsh Assembly Government: Cardiff, Wales, 2010. [Google Scholar]
The Scottish Government. Scotland' s Climate Change Adaptation Framework: Health and Wellbeing Sector Action Plan; The Scottish Government: Edinburgh, Scotland, 2007; pp. 1–16. [Google Scholar]
Department for Environment Food and Rural Affairs England. The National Adaptation Programme: Making the Country Resilient to a Changing Climate; London, UK, 2013. [Google Scholar]
Ministry of the Environment Czech Republic. National Program to Abate the Climate Change Impacts in the Czech Republic; Government of Czech Republic: Prague, Czech Republic, 2004. [Google Scholar]
Committee to the Ministry of the Environment. Adapting to a Changing Climate. Official Norwegian Reports NOU 2010:10; Government of Norway: Oslo, Norway, 2010. [Google Scholar]
Climate Change Impacts Study Committee. The Environmental, Economic and Social Impacts of Climate Change in Greece; Government of Greece: Athens, Greece, 2011. [Google Scholar]
EuroGeographics Europe Administrative Boundaries. Available online: http://epp.eurostat.ec.europa.eu/portal/page/portal/gisco_Geographical_information_maps/popups/references/administrative_units_statistical_units_1 (accessed 15 September 2014).
Van Dijk, T. Multidisciplinary CDA: A plea for diversity. In Methods of critical discourse analysis; Wodak, R., Meyer, M., Eds.; Sage: London, UK, 2002; pp. 95–120. [Google Scholar]
Fairclough, I.; Fairclough, N. Political Discourse Analysis. A Method for Advanced Students; Routledge: London, UK, 2012. [Google Scholar]
Mimura, N.; Pulwarty, R.; Duc, D.M.; Elshinnawy, I.; Redsteer, M.H.; Huang, H.-Q.; Nkem, J.N.; Rodriguez, R.A.S.; van Aalst, M.; Donohue, J.; et al. Adaptation planning and management. In Intergovernmental Panel on Climate Change 5th Assessment Report. Working Group II Report; Cambridge University Press: Cambridge, UK, 2014. [Google Scholar]
Bittner, M.-I.; Matthies, E.F.; Dalbokova, D.; Menne, B. Are European countries prepared for the next big heat-wave? Eur. J. Public Health 2013, 24, 615–619. [Google Scholar]
Adger, W.N.; Dessai, S.; Goulden, M.; Hulme, M.; Lorenzoni, I.; Nelson, D.R.; Naess, L.O.; Wolf, J.; Wreford, A. Are there social limits to adaptation to climate change? Clim. Change 2008, 93, 335–354. [Google Scholar]
Biesbroek, G.R.; Swart, R.J.; Carter, T.R.; Cowan, C.; Henrichs, T.; Mela, H.; Morecroft, M.D.; Rey, D. Europe adapts to climate change: Comparing national adaptation strategies. Glob. Environ. Chang. 2010, 20, 440–450. [Google Scholar] [CrossRef]
Risher, J.F.; Todd, G.D.; Meyer, D.; Zunker, C.L. The elderly as a sensitive population in environmental exposures: Making the case. Rev. Environ. Contam. Toxicol. 2010, 207, 95–157. [Google Scholar]
Rechel, B.; Mladovsky, P.; Ingleby, D.; Mackenbach, J.P.; McKee, M. Migration and health in an increasingly diverse Europe. Lancet 2013, 381, 1235–1245. [Google Scholar]
Taylor, S. What is Discourse Analysis? "What is?" Research methods series; Bloomsbury: London, UK, 2013. [Google Scholar]
Wooffitt, R. Conversation Analysis and Discourse Analysis; Sage: London, UK, 2006. [Google Scholar]
O'Brien, K.L.; Wolf, J. A values-based approach to vulnerability and adaptation to climate change. Wiley Interdiscip. Rev. Clim. Chang. 2010, 1, 232–242. [Google Scholar]
Van Dijk, T. Principles of critical discourse analysis. Discourse Soc. 1993, 4, 249–283. [Google Scholar]
Morgan, J.; Waskow, D. A new look at climate equity in the UNFCCC. Clim. Policy 2013, 14, 1–6. [Google Scholar]
Böhmelt, T. Civil society lobbying and countries' climate change policies: A matching approach. Clim. Policy 2013, 13, 698–717. [Google Scholar] [CrossRef]
Balbus, J.M.; Bouma, M.; Kovats, S.; LeSueur, D.; Martens, W.C.; Patz, J. Human health. In Handbook on Methods for Climate Change Impact Assessment and Adaptation Strategies; Feenstra, J.F., Burton, I., Smith, J.B., Tol, R.S.J., Eds.; United Nations Environment Programme (UNEP): Nairobi, Kenya; Vrije Universiteit Amsterdam: Amsterdam, The Netherlands, 1998; Volume 2, pp. 10–31. [Google Scholar]
Said, E.W. Orientalism; 25 Annive; Vintage Books: New York, NY, USA, 2003. [Google Scholar]
United Nations Framework Convention on Climate Change FOCUS: Mitigation—NAMAs, Nationally Appropriate Mitigation Actions. Available online: http://unfccc.int/focus/mitigation/items/7172.php (accessed on 21 August 2014).
Nguyen, M.T. The Gift of Freedom: War, Debt, and Other Refugee Passages; Duke University Press: Durham, NC, USA, 2012. [Google Scholar]
Lesnikowski, A.C.; Ford, J.D.; Berrang-Ford, L.; Paterson, J.A.; Barrera, M.; Heymann, S.J. Adapting to health impacts of climate change: A study of UNFCCC Annex I parties. Environ. Res. Lett. 2011, 6. [Google Scholar] [CrossRef]
Wilhelmi, O.V.; Hayden, M.H. Connecting people and place: A new framework for reducing urban vulnerability to extreme heat. Environ. Res. Lett. 2010, 5. [Google Scholar] [CrossRef]
Bolte, G. Environment-related inequalities. In Environmental health inequalities in Europe. Assessment report; World Health Organization, Ed.; WHO Regional Office for Europe: Copenhagen, Denmark, 2012; pp. 86–113. [Google Scholar]
Wardekker, J.A.; de Jong, A.; van Bree, L.; Turkenburg, W.C.; van der Sluijs, J.P. Health risks of climate change: An assessment of uncertainties and its implications for adaptation policies. Environ. Heal. 2012, 11. [Google Scholar] [CrossRef]
Ebi, K.L.; Semenza, J.C. Community-based adaptation to the health impacts of climate change. Am. J. Prev. Med. 2008, 35, 501–507. [Google Scholar] [CrossRef]
Falloon, P.; Betts, R. Climate impacts on European agriculture and water management in the context of adaptation and mitigation—The importance of an integrated approach. Sci. Total Environ. 2010, 408, 5667–5687. [Google Scholar] [CrossRef]
Kunreuther, H.; Heal, G.; Allen, M.; Edenhofer, O.; Field, C.B.; Yohe, G. Risk Management and Climate Change; NBER Working Paper; Cambridge: MA, USA, 2012. [Google Scholar]
Cheng, J.J.; Berry, P. Health co-benefits and risks of public health adaptation strategies to climate change: A review of current literature. Int. J. Public Health 2013, 58, 305–311. [Google Scholar]
Remais, J.V.; Hess, J.J.; Ebi, K.L.; Markandya, A.; Balbus, J.M.; Wilkinson, P.; Haines, A.; Chalabi, Z. Estimating the health effects of greenhouse gas mitigation strategies: Addressing parametric, model, and valuation challenges. Environ. Health Perspect. 2014, 122, 447–455. [Google Scholar]
Horton, R.; Beaglehole, R.; Bonita, R.; Raeburn, J.; McKee, M.; Wall, S. From public to planetary health: A manifesto. Lancet 2014, 383. [Google Scholar] [CrossRef] [PubMed]
Bassil, K.L.; Cole, D.C. Effectiveness of public health interventions in reducing morbidity and mortality during heat episodes: A structured review. Int. J. Environ. Res. Public Health 2010, 7, 991–1001. [Google Scholar] [CrossRef]
Toloo, G.; Fitzgerald, G.; Aitken, P.; Verrall, K.; Tong, S. Evaluating the effectiveness of heat warning systems: Systematic review of epidemiological evidence. Int. J. Public Health 2013, 58, 667–681. [Google Scholar] [CrossRef]
O'Brien, K. Global environmental change II: From adaptation to deliberate transformation. Prog. Hum. Geogr. 2011, 36, 667–676. [Google Scholar]
Townshend, T.; Fankhauser, S.; Aybar, R.; Collins, M.; Landesman, T.; Nachmany, M.; Pavese, C. How national legislation can help to solve climate change. Nat. Clim. Chang. 2013, 3, 430–432. [Google Scholar] [CrossRef]
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There's many the example of spring adorning small bathrooms from traditional design until fashionable design, which the design of loo with natural nuance. Surely, you want to personal the cute lavatory decor in your house. There's many a selection design of the bathroom ornament then you can select considered one of them that you simply like.
You may prepare your decorative rest room towels uniquely. You can even select white and brown plus green or other colours that you simply need to design your trendy bathroom decor. You can combine the colors or you can also make with sample design within the wall of your bathroom.
Those decorative mirrors for bathrooms designed with nature nuance, so you'll be able to add the green crops or something flowers that you just want to add the nuance in your holiday bathroom decor. The green vegetation and the favorite flowers make any house to alive also recent and astounding. Usually there is crops in the green toilet decor are rare because there isn't any house of the vegetation for growing resulting from lack of area in this room.
But, in the event you can organized nicely, the plants that you select can growing and the ornamental bathroom equipment will draw by it is vegetation. You may select a lot type of contemporary flowers that you want comparable to jasmine as well as rose also orchids or tulips and different in your bathroom in order seen beautiful.
Tags : bath ideas. bathroom decorating. bathroom decorating ideas. bathroom decoration. bathroom decorations. bathroom design ideas. bathroom styles. bathrooms.


text:
Rebecca Wragg Sykes is a British Paleolithic archaeologist, broadcaster, popular science writer and author who lives in Wales. She is interested in the Middle Palaeolithic, specifically in the lives of Neanderthals; and she is one of the founders of TrowelBlazers, a website set up to celebrate the lives of women in archaeology, palaeontology and geology.

Career
Wragg Sykes studied as an undergraduate at the University of Bristol, before gaining her BA in Archaeology in 2003, and MA in the Archaeology of Human Origins from the University of Southampton in 2004. Her doctoral thesis from the University of Sheffield, which examined evidence for late Neanderthals in Britain, was awarded in 2010.

Following her Ph.D, Wragg Sykes was awarded a Marie Curie postdoctoral fellowship at Université de Bordeaux, working in the PACEA laboratory on Neanderthal and prehistoric sites in the Massif Central mountains. She is currently an Honorary Fellow in the School of Archaeology, Classics and Egyptology at the University of Liverpool, and chercheur bénévole (Honorary Fellow) at the Université de Bordeaux.

Science communication
Wragg Sykes has written for The Guardian, Scientific American and Aeon, and appeared on history and science programmes for BBC Radio 3 and Radio 4.

In 2020, Wragg Sykes published Kindred: Neanderthal Life, Love, Death and Art which won the 2021 Current Archaeology Book of the Year Award, the 2021 Hessel-Tiltman History Prize, and has been favourably reviewed by Current Archaeology, London Review of Books, Nature, The Guardian and The New York Times; reviews have been published in other media outlets as well.

Yuval Noah Harari, author of the bestseller Sapiens: A Brief History of Humankind, thought Wragg Sykes had done "a remarkable job synthesizing thousands of academic studies into a single accessible narrative". Alice Roberts, author and presenter of the television series The Incredible Human Journey, said it was "a wonderful portrait of these enigmatic, long-lost relatives".
Writing in The Sunday Times about the best philosophy and ideas books of the year 2020, James McConnachie praised how it reveals the latest theories about Neanderthal life, from the tools they used to the funerals they performed.

Wragg Sykes has also written for DK and was one of the authors for the book Big History, although she and the other authors were "aligned with" the OER Project rather than members of the organization.

TrowelBlazers
In 2013, Wragg Sykes started, together with fellow scientists Brenna Hassett, Suzanne Birch, and Victoria Herridge, the TrowelBlazers project, a public-led experiment in participatory archaeology, originating from the lack of visibility of women in science. TrowelBlazers has highlighted women from the fields of archaeology, geology and palaeontology.

References

External links

Year of birth missing (living people)
British women archaeologists
British broadcasters
British science writers
British palaeontologists
Alumni of the University of Bristol
Alumni of the University of Southampton
Alumni of the University of Sheffield
Academic staff of the University of Bordeaux
Academics of the University of Liverpool
Living people

redpajama_set_name: RedPajamaWikipedia


text:
2Day FM Axe Grant, Ed & Ash Breakfast Show
Written by Alex Gallagher on August 15, 2019
2Day FM have announced that its breakfast show, hosted by Grant Denyer, Ed Kavalee and Ash London, has been cancelled, with its final episode set to be broadcast this Friday.
In its stead, the network will launch a new "Music for Breakfast" program from next Monday which will provide "an exciting and upbeat breakfast alternative for Sydneysiders on their morning commute where they can expect us to play just music for breakfast," according to head of Hit Network Gemma Fordham.
The network head thanked the trio for their work over the past 18 months. "They are absolute professionals, have been a true delight to work with and have contributed to a culture of fun, community and inclusiveness we are proud of at 2Day."
As the Sydney Morning Herald points out, the show fell to its lowest ratings in nearly two years last month, with just 3.1% of the total breakfast audience.
In a statement released today, the network confirmed that all three hosts would remain involved with the network. London will continue to host her nightly Ash London Live program, Kavalee will fill in for Kate Langbroek with Dave Hughes, and Denyer will be "making appearances around the network."
Brockhampton Have Dropped Yet Another Song 'Boy Bye' & Reveal 'Ginger' TracklistSydney's City Recital Hall Are Throwing A Special 20th Anniversary Concert Curated By Megan Washington
2Day FM
Ash London

redpajama_set_name: RedPajamaCommonCrawl


Often situated in unlikely far-flung locations that require customers to travel further outside their catchment comfort zones, outlet centres have historically avoided the spotlight. However, this is about to change as new urban outlet centres continue to emerge and prove to be one of the few bright spots in the retail sector – increasingly piquing the interest of investors, landlords and shoppers alike.
In this week's news, Savills Investment Management (SIM) made its first acquisitions in the outlet centre market with a €300m deal for two French assets. The two outlet centres managed by @McArthurGlenUK represent a total area of 47 300 m2, including the outlet centre of Troyes which is the largest designer outlet of France. SIM sees an opportunity in this often-overlooked sector to achieve "attractive distribution" across their various ownerships. Meanwhile, some outlet centres operators are taking advantage of growing interest in the asset type by selling off parts of their portfolio– with the recent marketing of Spanish outlet managers Neinver providing further evidence of activity across the market. Local Spanish media reported that Neinver's owners were asking for €500 million and have appointed Credit Suisse to look for potential buyers.
With #outletmallinvestments hitting records in the last quarter of 2018 at €1.7 billion, according to TH Real Estate data, their attractiveness for investors have never been more evident. Outlets have become a defensive investment and an alternative sales channel in the face of growing popularity of online retail – as well as being counter-cyclical versus main-stream retail. With lower levels of volatility compared to other real assets – as seen throughout the last economic cycle, they provide consumers with higher quality and tailored shopping experience. Operators have also begun to increasingly invest into the catering facilities to maximise dwell time, and position their marketing to suit the new, experience-oriented customer.
At the moment, experts argue that outlet centres are best placed to weather the current #retailstorm but as retail is a cyclical industry, will 2019 be the year when the tide will turn?


With half of the year over, the real estate market in Northern Virginia has slowed to a normal pace. This has put some sellers and Realtors in a bit of a panic as they felt the brisk market we experienced earlier this year was going to continue for a longer time than it did. It is important to understand that the frenetic pace of sales in February, March and into April was not sustainable nor the norm. We still are experiencing sales, but houses are not selling in hours or days for the most part, but are now selling in weeks, which is what is the expected time frame. Buyers are being more selective and taking their time making decisions which, again, is normal. Keep in mind, there is now more inventory and houses are staying on the market longer which means more choices and time for buyers to make decisions. If you are the seller, please know that this is okay. Your house will sell if it has a compelling price, is in great condition and a in nice location, it just won't sell as fast as your neighbor's house did earlier this year. Keep in mind, we are still seeing multiple offers on homes that meet the conditions above.
The real estate market can and does change on a dime. Important factors to pay attention to are: inventory levels in your price range, days on market – both average and median, and prices – if are they up or if are they are down. Every market is different and therefore deserves special attention which we can help you analyze. Experience matters so be sure to reach out to us if you are considering selling.
Interest rates on mortgages increased but have recently eased back down which is good news for buyers. We expect to be in this type of environment through the end of the year – somewhere between 4.5 and 5% for 30 -year fixed loans. These are awesome rates for sure, which is important for buyers to remember. The theory is higher rates will affect first time buyers in lower price points more than move up buyers or even first-time buyers in higher price points, so keep an eye out if you are considering a purchase. We are here to help you determine what loan program is best for you. We are full service!
Have a very Happy 4th of July celebrating with family and friends. Be safe!


The First Army is the oldest and longest established field army of the United States Army. It now serves as a mobilization, readiness and training command.
In 1938, First Army came under command of General Hugh A. Drum. Drum who along with a build up of the Army in 1939 and through the early 1940s began to develop First Army into a bonafide field army. It began to establish and develop its own staff and participated in the large scale Army maneuvers in Louisiana and North Carolina between 1939 and 1941. As the United States entered World War II, Drum was assigned a new command of the newly established Eastern Defense Command, responsible for coastal and domestic defense. Drum retired in 1943 when he reached mandatory retirement age. General George Grunert, commander of Second Service Command assumed command of First Army until Headquarters, First Army was activated in Bristol England in January 1944 under command of General Omar Bradley.
Upon going ashore on 6 June 1944, D-Day, First Army came under 21st Army Group and commanded all American ground forces during the invasion. Three American divisions were landed by sea at the Western end of the beaches, and two more were landed by air. On Utah Beach the assault troops made good time, but Omaha Beach came nearest of all of the five landing areas to disaster. The two American airborne divisions that landed were scattered all over the landscape, and caused considerable confusion amongst the German soldiers, as well as largely securing their objectives, albeit with units completely mixed up with each other. First Army captured much of the early gains of the Allied forces in Normandy. Once the beachheads were joined up, its troops struck west and isolated the Cotentin Peninsula, and then captured Cherbourg. When the American Mulberry harbour was wrecked by a storm, Cherbourg became much more vital than it had been thought it would be.
After capturing Paris (the 'Wehrmachtbefehlshaber von Groß-Paris', Dietrich von Choltitz, capitulated 25 August, ignoring Hitler's "Trümmerfeldbefehl") , First Army headed towards the south of the Netherlands.
When the Germans attacked during the Battle of the Bulge, First Army found itself on the north side of the salient, and thus isolated from 12th Army Group, its commanding authority. It was therefore transferred, along with Ninth Army, to 21st Army Group on 20 December. The salient was reduced by early February 1945. Following the Battle of the Bulge, the Rhineland Campaign began, and First Army was transferred back to 12th Army Group. In Operation Lumberjack, First Army closed up to the lower Rhine by 5 March, and the higher parts of the river five days later.
On 7 March, in one of the great strokes of luck of war, First Army found an intact bridge across the Rhine at Remagen. It crossed the river in force quickly. By 4 April, an enormous pocket had been created by First Army and Ninth Army, which contained the German Army Group B under Field Marshal Model, the last significant combat force in the north west of Germany. Whilst some elements of First Army concentrated upon reducing the Ruhr pocket, others headed further east, creating another pocket containing the German Eleventh Army. First Army reached the Elbe by 18 April. There the advance halted, as that was the agreed demarcation zone between the American and Soviet forces. First Army and Soviet forces met on 25 April.
First Army inactivated its training divisions, reflagging them as separate training brigades under two commands. First Army Division East, headquartered at Fort George G. Meade, Maryland has responsibilities in all states east of the Mississippi River; and First Army Division West assuming Fifth Army's role and relocating from Fort Carson to its new headquarters at Fort Hood, Texas, oversees units in all states west of the Mississippi River.
1 December 2006, First Army reorganizes and reflags its five Reserve Component Training Support Divisions into 16 training brigades and establishes two sub-commands, First Army Division East and First Army Division West. First Army East at Fort Meade, Maryland administers eight brigades east of the Mississippi River and First Army West at Fort Hood, Texas, assumes the training responsibilities with eight brigades formally held by U.S. Fifth Army. Fifth Army becomes U.S. Army, North, and assumes First Army's domestic assistance duties.
158th "Warrior" Infantry Brigade – Patrick Air Force Base, Florida. Formerly the 87th Division's 2nd Brigade.
4th "Saber" Cavalry Brigade – Fort Knox, Kentucky. Formerly the 85th Division's 4th Brigade.
120th Infantry Brigade – Fort Hood, Texas. Formerly the 75th Division's 2nd Brigade.
20px 166th Aviation Brigade – Fort Hood, Texas. Formerly the 75th Division's 3rd Brigade.
181st "Eagle" Infantry Brigade – Fort McCoy, Wisconsin. Formerly the 85th Division's 2nd Brigade.
402nd Field Artillery Brigade – Fort Bliss, Texas. Formerly the 91st Division's 3rd Brigade.
5th Armored Brigade – Fort Bliss, Texas. Formerly the 91st Division's 2nd Brigade.
189th "Bayonet" Infantry Brigade – Fort Bragg, North Carolina. Formerly the 78th Division's 4th Brigade.
This article incorporates public domain material from the United States Army Center of Military History website http://www.history.army.mil/BOOKS/Lineage/ACDSB/FUSA.htm.
"First United States Army". Armies, Corps, Division and Separate Brigades. United States Army Center of Military History. 1999. CMH Pub 60-7-1. http://www.history.army.mil/books/Lineage/ACDSB/FUSA.htm.


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About Infrastructure of Czech Republic
Phones - Land Lines
2.1 million (2012)
Mobile Cellular
12.973 million (2012)
Radio Broadcast Stations
roughly 130 TV broadcasters operating some 350 channels with 4 publicly operated and the remainder in private hands; 16 TV stations have national coverage with 4 being publicly operated; cable and satellite TV subscription services are available; 63 radio
6.681 million (2009)
total: 9,469 km
standard gauge: 9,449 km 1.435-m gauge (3,165 km electrified)
narrow gauge: 20 km 0.750-m gauge (2008)
total: 130,671 km (includes urban roads)
paved: 130,671 km (includes 730 km of expressways) (2010)
664 km (principally on Elbe, Vltava, Oder, and other navigable rivers, lakes, and canals) (2010)
river port(s): Prague (Vltava); Decin, Usti nad Labem (Elbe)
registered in other countries: 1 (Saint Vincent and the Grenadines 1) (2010)


text:
Home intimidation
Statement from UAW President Dennis Williams on Today's Nissan Vote
"The courageous workers of Nissan, who fought tirelessly for union representation alongside community and civil-rights leaders, should be proud of their efforts to be represented by the UAW. The result of the election was a setback for these workers, the UAW and working Americans everywhere, but in no way should it be considered a defeat.
Stand with Nissan employees before it's too late
Next week marks the culmination of one of the biggest civil rights battles in a generation. Thousands of people who work at Nissan's Canton, Mississippi factory will vote whether to join together in union to improve their jobs and communities. Veteran auto assemblers are uniting to protest dangerous conditions, insecure permatemp jobs, and punishing schedules.
Trumps words and actions when it comes to workers: workers always lose
UAW members are workers who believe in collective bargaining rights. We know they're the foundation of fair treatment in the workplace, good health care coverage for our families, job safety, retirement security and everything we negotiate as equals with management. Voting for Donald Trump for president in November is the same as voting against your


One of the aims of the project Environment and Economy at the National Institute of Public Health and Environmental Protection (RIVM) is to develop a model which can transform monetary units into fysical units. This model is used for the National Environmental Outlooks. The model (the so called 'transformation model') is developing continuously. The Environmental Forecasting Bureau (MTV), part of the RIVM, wants to review the assumptions which are used to model the fysical inputs and outputs of the building industry sector of the Dutch economy. This study is the result of that intention. The main results of the study are: The fysical growth rate of cement is considered to be representative for the whole fysical input of the building industry sector. The reliability can be improved by taking more variables into account. The growth rate of the outputs depend on the planned construction activities. The main proposed improvement is to divide the forecasting time horizon in parts.


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Maui Author Toby Neal Wins National Book Award
April 14, 2016, 8:22 AM HST
* Updated April 14, 8:24 AM
Toby Neal photo credit: Mike Neal at Nealstudios.com
Author Toby Neal, a Makawao resident known internationally for her writing, won a Bronze Medal in the 2016 Independent Publisher Book (IPPY) award for her USA Today Bestselling book, Rip Tides and was also recognized as a Notable Indie in 2015 by Shelf Unbound.
The "IPPY" Awards, in its 20th year, are designed to bring increased recognition to the deserving but often unsung titles published by independent authors and publishers. Shelf Unbound book review magazine annually offers the Shelf Unbound Competition for Best Indie/Self-Published Book.
Rip Tides is the ninth book in her bestselling Lei Crime Series—mysteries that take place in Hawai'i.
The series centers on Leilani "Lei" Matsumoto Texeira, a multicultural female detective who solves a range of complicated mysteries in the Hawaiian Islands.
Rip Tides is a suspenseful story that takes place on the North Shore of O'ahu, where Texeira investigates the murder of Maui surf star Makoa Simmons.
Dark and tangled motives reach deep into the elite world of professional surfing. Neal's career as a clinical social worker informs the depth and complexity of the characters in her books.
Neal grew up on Kaua'i. After a few "stretches of exile" to pursue education, the islands have been home for the last 17 years. She is very familiar with the local surfing scene.
"Surfing is close to my heart," said Neal. "I come from a three generation surfing family. I surfed myself when I was younger and I married a surfer."
For a week in January 2015, Neal returned to the North Shore of O'ahu during book research trip; her family had lived in a beach cottage there from 1967 to 1970.
"I loved being on that famous stretch of golden sand, hearing the thunder of the breaking waves through the night, watching the most amazing surfing in the world during the day," said Neal.
In writing Rip Tides, her immersion experience that winter shaped her descriptions, which were particularly rich, because she went to Pipeline and hung out at the beach to investigate the scene.
"I even found the beach cottage where our family lived," said Neal. "I'm also gathering material for my memoir, so locating it was exciting!"
Neal is the author of 19 novels and several novellas in the mystery, contemporary romance and young adult genres. The Lei Crime Series debuted with Blood Orchids in December of 2010 and the books have been featured on the USA Today bestseller list, with eBook downloads of close to a million and more than 10,000 print copies sold.
In 2015, Amazon launched the Lei Crime Kindle World, which allows authors to build upon Neal's works through special licensing agreements. There are now 33 top-reviewed works in the fan fiction world starring Neal's characters.
This month, Neal's stories, along with many other top quality works, launched on the free Tapas app, a platform that "gamifies reading." Tapas is the first market player in the US to apply the proven business model of free-to-play games and apply it to mobile reading. Users start by reading chapters free, and then unlock subsequent episodes as they progress using virtual keys while having the option to unlock the complete book at any time.
For more information, visit http://tobyneal.net.
Certified Occupational Therapy Assistant - Kula Hospital
KTA Super Stores President and COO Toby Taniguchi… May 7, 2021
Maui County Council wins national award for… August 24, 2022
Tyler Wright Wins Maui Pro; John John Florence Wins… December 21, 2020
Maui Best-selling Author Delivers TEDx Talk About… December 7, 2020
Author December 20, 2020
Nisei Veterans Memorial Center Welcomes Tom Coffman… March 14, 2021


Carpal Tunnel Syndrome is caused by long term repetitive motion in the ligaments and nerves of a person's wrist. People that are suffering from Carpal Tunnel Syndrome have an array of options when trying to relieve their pain.
Wearing a brace on the affected hand and wrist offers support and relieves pain. Wearing a splint during sleep eliminates hand movement and has proven to be very effective.
Changing work routines or modifying the behaviors that caused the Carpal Tunnel Syndrome will help reduce the symptoms and pain of the condition. A person who is able to eliminate the reason for the condition will often see dramatic improvements in their pain levels.
A physician may offer an anti-inflammatory pain medication to help reduce pain. Ibuprofen is a good option for a non-prescription pain reliever.
A patient with severe Carpal Tunnel Syndrome symptoms may be offered cortisone steroid injections to relieve pain. This type of injection offers pain relief but symptoms will often return requiring further shots or medical intervention.
A physician may recommend surgery depending on the severity of the condition. Surgery will alleviate the pressure on the ligaments and nerve which will allow the hand to heal and the pain to be eliminated. Most patients will require between two months to a year of recovery time after surgery to realize optimal results.


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Q: Fieldsets not showing up in summary bar I have created a price form. It has collapsible fieldsets that I want to show up on the pricing summary. The first fieldset shows up, however the rest will not. Am I missing something? Or do I need to delete something in my code? Please help. The site is: www.azaservice.com/mscalc.html   Thank you!

A: Your other fieldset elements aren't showing up because they are not found inside your form.jquery-order-form element. Your script at the bottom of the page initializes the jPrice plugin on this form element. Move your </form> tag to the end of your fieldset elements, and I bet it starts working. Essentially, it should look something like this where all your fieldset elements are children of the form element.
<form class="jquery-order-form">

    <fieldset>...</fieldset>
    <fieldset>...</fieldset>
    <fieldset>...</fieldset>
    <fieldset>...</fieldset>

...

</form>

Update: Your issues are caused by the structure of your markup. I have updated the example above to give you an idea as to how it "should" look. I have not included all of your original markup, but what's here should get you to your goal.
Here's what your complete code would probably look like:

AzaService Managed Services Calculator

  <form id="jquery-order-form" class="jof form-horizontal right" action="submit.php" method="post" enctype="multipart/form-data">

      <fieldset id="fieldset1" class="coolfieldset collapsed">
        <legend>Windows Servers</legend>

Service Level:

                <input type="radio" data-cost="400" value="8x5" name="f_1">
                 8 x 5
                 - $400.00

                <input type="radio" checked="checked" data-cost="480" value="24x7" name="f_1">
                 24 x 7
                 - $480.00

Services:

                <input type="checkbox" data-cost="3" value="Antivirus" name="f_2[]">
                 Antivirus
                 - $3.00

                <input type="checkbox" checked="checked" data-cost="50" value="Onsite" name="f_2[]">
                 Onsite
                 - $50.00

                <input type="checkbox" checked="checked" data-cost="20" value="Backup" name="f_2[]">
                 Backup
                 - $20.00

      </fieldset>
      Number of Windows Servers:
        <input type="number" name="q_1" id="q_1" value="1" data-quantity="f_1,f_2[]">

      <fieldset id="fieldset2" class="coolfieldset collapsed">
        <legend>Linux Servers</legend>

Service Level:

                <input type="radio" data-cost="400" value="8x5" name="f_3[]">
                 8 x 5

                <input type="radio" checked="checked" data-cost="480" value="24x7" name="f_3[]">
                 24 x 7

Services:

                <input type="checkbox" data-cost="3" value="Antivirus" name="f_4[]">
                 Antivirus

                <input type="checkbox" checked="checked" data-cost="50" value="Onsite" name="f_4[]">
                 Onsite

                <input type="checkbox" checked="checked" data-cost="20" value="Backup" name="f_4[]">
                 Backup

      </fieldset>
      Number of Linux Servers:
        <input type="number" name="q_2" id="q_2" value="2" data-quantity="f_3[],f_4[]">

      <fieldset id="fieldset3" class="coolfieldset collapsed">
        <legend>Unix Servers</legend>

Service Level:

                <input type="radio" data-cost="400" value="8x5" name="f_5[]">
                 8 x 5

                <input type="radio" checked="checked" data-cost="480" value="24x7" name="f_5[]">
                 24 x 7

Services:

                <input type="checkbox" data-cost="3" value="Antivirus" name="f_6[]">
                 Antivirus

                <input type="checkbox" checked="checked" data-cost="50" value="Onsite" name="f_6[]">
                 Onsite

                <input type="checkbox" checked="checked" data-cost="20" value="Backup" name="f_6[]">
                 Backup

      </fieldset>
      Number of Unix Servers:
        <input type="number" name="q_3" id="q_3" value="3" data-quantity="f_5[],f_6[]">

      <fieldset id="fieldset4" class="coolfieldset collapsed">
        <legend>Windows Workstations</legend>

Service Level:

                <input type="radio" data-cost="55" value="8x5" name="f_7[]">
                 8 x 5

                <input type="radio" checked="checked" data-cost="66" value="24x7" name="f_7[]">
                 24 x 7

Services:

                <input type="checkbox" data-cost="2" value="Antivirus" name="f_8[]">
                 Antivirus

                <input type="checkbox" checked="checked" data-cost="10" value="Onsite" name="f_8[]">
                 Onsite

                <input type="checkbox" checked="checked" data-cost="5" value="Backup" name="f_8[]">
                 Backup

      </fieldset>
      Number of Windows Workstations:
        <input type="number" name="q_4" id="q_4" value="4" data-quantity="f_7[],f_8[]">

      <fieldset id="fieldset5" class="coolfieldset collapsed">
        <legend>Linux Workstations</legend>

Service Level:

                <input type="radio" data-cost="55" value="8x5" name="f_9[]">
                 8 x 5

                <input type="radio" checked="checked" data-cost="66" value="24x7" name="f_9[]">
                 24 x 7

Services:

                <input type="checkbox" data-cost="2" value="Antivirus" name="f_10[]">
                 Antivirus

                <input type="checkbox" checked="checked" data-cost="10" value="Onsite" name="f_10[]">
                 Onsite

                <input type="checkbox" checked="checked" data-cost="5" value="Backup" name="f_10[]">
                 Backup

      </fieldset>
      Number of Linux Workstations:
        <input type="number" name="q_5" id="q_5" value="5" data-quantity="f_9[],f_10[]">

      <fieldset id="fieldset6" class="coolfieldset collapsed">
        <legend>Unix Workstations</legend>

Service Level:

                <input type="radio" data-cost="55" value="8x5" name="f_11[]">
                 8 x 5

                <input type="radio" checked="checked" data-cost="66" value="24x7" name="f_11[]">
                 24 x 7

Services:

                <input type="checkbox" data-cost="2" value="Antivirus" name="f_12[]">
                 Antivirus

                <input type="checkbox" checked="checked" data-cost="10" value="Onsite" name="f_12[]">
                 Onsite

                <input type="checkbox" checked="checked" data-cost="5" value="Backup" name="f_12[]">
                 Backup

      </fieldset>
      Number of Unix Workstations:
        <input type="number" name="q_6" id="q_6" value="6" data-quantity="f_11[],f_12[]">

      <fieldset id="fieldset7" class="coolfieldset collapsed">
        <legend>Mobile Units</legend>

Service Level:

                <input type="radio" data-cost="40" value="8x5" name="f_13[]">
                 8 x 5

                <input type="radio" checked="checked" data-cost="48" value="24x7" name="f_13[]">
                 24 x 7

Services:

                <input type="checkbox" data-cost="50" value="Antivirus" name="f_14[]">
                 Antivirus

                <input type="checkbox" checked="checked" data-cost="50" value="Backup" name="f_14[]">
                 Backup

      </fieldset>
      Number of Mobile Units:
        <input type="number" name="q_7" id="q_7" value="7" data-quantity="f_13[],f_14[]">

      <fieldset id="fieldset8" class="coolfieldset collapsed">
        <legend>Networks</legend>

Service Level:

                <input type="radio" data-cost="30" value="8x5" name="f_15[]">
                 8 x 5

                <input type="radio" checked="checked" data-cost="36" value="24x7" name="f_15[]">
                 24 x 7

Services:

                <input type="checkbox" data-cost="50" value="Onsite" name="f_16[]">
                 Onsite

      </fieldset>
      Number of Networks:
        <input type="number" name="q_8" id="q_8" value="8" data-quantity="f_15[],f_16[]">

        <input class="submit btn btn-primary btn-large" type="submit" value="Send it Off!">

Total: $4939.00

        <input type="hidden" id="total-cost" name="total-cost" value="4939">

Summary:

Windows Server Service Level: 24x7

Windows Server Services:

Onsite

Backup

Number of Windows Servers: 1

Linux Server Service Level: 24x7

Linux Server Services:

Onsite

Backup

Number of Linux Servers: 2

Unix Server Service Level: 24x7

Unix Server Services:

Onsite

Backup

Number of Unix Servers: 2

Windows Workstation Service Level: 24x7

Windows Workstation Services:

Onsite

Backup

Number of Windows Workstations: 4

Linux Workstation Service Level: 24x7

Linux Workstation Services:

Onsite

Backup

Number of Linux Workstations: 5

Unix Workstation Service Level: 24x7

Unix Workstation Services:

Onsite

Backup

Number of Unix Workstations: 6

Mobile Service Level: 24x7

Mobile Services: Backup

Number of Mobile Units: 7

Network Service Level: 24x7

Number of Networks: 8

  </form>

redpajama_set_name: RedPajamaStackExchange


text:
Kelsey Grammer Among Juried Emmy Award Winners for 'Simpsons' Voiceover
LOS ANGELES – Being heard and not seen was enough for Kelsey Grammer to win an Emmy Award for his voiceover performance as Sideshow Bob on Fox's "The Simpsons."
Grammer's honor was among the juried awards announced this week by the Academy of Television Arts & Sciences. They'll be presented at the Emmy creative arts ceremony on Aug. 19.
Grammer can add his latest trophy, for the animated show's episode titled "The Italian Bob," to the four he won as best actor in a comedy for "Frasier."
Nominees for the main Emmy ceremony, airing Aug. 27 on NBC with host Conan O'Brien, were announced earlier this month.
Other juried award winners announced Wednesday:
— Costumes for a variety or music program: Wendy Benbrook, Wanda Leavey, "MADtv," episode 1109, Fox; Erin Lareau, "Benise: Nights of Fire!" PBS; Dana Campbell, Randall Christensen, "Dancing with the Stars," episode 208A, ABC.
— Individual achievement in animation: Jarek Szyszko, "Classical Baby 2," Hippo Dance segment, HBO; Sarah E. Meyer, "Robot Chicken," Easter Basket episode, Cartoon Network; Frederick Gardner, "The Life and Times of Juniper Lee," Adventures in Babysitting episode, Cartoon Network; Bryan Arnett, "Escape From Cluster Prime," Nickelodeon; Shannon Tindle, "Foster's Home For Imaginary Friends," Go Goo Go episode, Cartoon Network; Mike Diederich, "The Grim Adventures of Billy & Mandy," Cartoon Network.


Aug 27-31, 2018 Newport RI. Trilogic Systems is excited to be joining SENEDIA and NUWC NPT in this years joint session which will be combining Defense Innovation Days 2018 with ANTX 2018. This will be the first year that the two events will be combined. Trilogic Systems will be have a booth once again at Defense Innovation Days joined by select partners. In addition we will be attending ANTX – Advanced Naval Technology Exercise – an event that allows industry academia and Government R&D organizations demonstrate emerging technologies in operationally relevant environments and scenarios.