The triple integration of data, users and policies required for successful climate health solutions

Successful digital health projects encompass diverse functions, combining one or even several technological elements. Across the digital climate health solutions analyzed, we find shared challenges regarding the integration of different data stocks, the integration of users in development of the process and efficient links with adherent policies.

Requirement 1: Integrating data stocks

Effective climate health tools rely on the integration of diverse types of data, including climate and weather data, clinical health data, and user-generated data. The required integration often faces challenges due to incomplete, fragmented or unharmonized data-sets, conflicting spatial and temproal scales, and at times also the quality of data gathered from different devices as well as by different disciplines and stakeholders. Different expert positions and, potentially even lay knowledge, have to be made commensurable in terms of compatibility and scale. In case of conflict, this may result in issues regarding the prioritization and validation of data and information¹². Concrete challenges include the integration of climate and weather data of different spatial and temporal resolution, medical taxonomies, the evaluation of physicians, and potentially subjective patient data input. Responsibility for the integration of these knowledge stocks often lays within the technical operationalisation of different features, with a tendency of obscuring the underlying decision-making process¹⁵. However, decisions made in this regard are crucial for the design and functionality of tools and applications.

Transdisciplinary approaches are key enablers for data integration, as these emphasize collaboration across disciplines as well as the inclusion and empowerment of non-academic stakeholders, especially patients, in the research and development process¹⁶. Transdisciplinary collaboration and patient-centered approaches are particularly relevant in the context of climate health, as the fruitful intersection of environmental science, public health, and social sciences is critical. An example of successful data integration is the development of the Climate Data Library by the International Research Institute for Climate and Society at Columbia University (NY), which was designed as an integrated data platform in order to support the use of climate and environmental information by global public health professionals and decision-makers¹⁷. Climate scientists initiated the database to support exploratory data analysis, and it now serves as a platform for transdisciplinary researchers focusing on topics related to climate impacts on society^12,17.

Developers of climate health tools should actively seek to integrate diverse stocks of information and data from the outset of the development process. Transdisciplinary approaches include engaging local communities, public health experts, and environmental scientists to ensure that tools are both scientifically robust and contextually relevant.

Requirement 2: Integrating users in the development process

The adoption and effectiveness of digital health tools depend on their usability and the extent to which they meet users’ needs¹⁸. In most countries, the healthcare delivery model is multi-layered, with doctors and nurses as primary providers. Often built from a providers’ perspective, many digital tools fail to gain traction due to a lack of user engagement in their development¹⁹. Accordingly, user-centered design (UCD) is a critical approach in this context, emphasizing the importance of involving users including patients, healthcare providers, or public health officials, during the development process²⁰. UCD plays a key role in achieving user engagement in the implementation phase, thus improving the likelihood of the intervention’s effectiveness, leading to higher adoption rates and better health outcomes^2,21.

Successful examples of user-centered design include mobile applications developed for people in unhealthy conditions like smoking, obesity, diabetes, and other chronic conditions that require behavioral changes for treatment³. These apps enable patients to track their condition and communicate with healthcare providers, as a means to motivate and track behavioral change²⁰. The European Union-funded “PulsAir” mobile application and data ecosystem, for instance, serves both for collecting data from users to assess the individual risk of patients with asthma and type 2 diabetes and involves gaming elements such as avatars, points, and rewards motivating citizens to take action towards healthier behaviors^22,23. User feedback on mock-up versions was integrated even before building the first prototype²². Once established, continued user feedback was shown to support strong links and active engagement with the application.

To enhance the adoption of climate health tools, developers should engage end-users in the first stages of the development process. This involves conducting user research, gathering feedback through iterative testing, and ensuring that the final product demonstrates high usability and effectively addresses the specific needs of its target users. Building a community of users who actively contribute to and benefit from the tool can then ensure its long-term user support.

Requirement 3: Integrating digital tools into public health policies

While the first two requirements target the development and use of applications, the third relates to their effective links to climate adapatation policies and public health strategies. Research has discovered multiple co-benefits between climate adaptation, mitigation and public health²⁴. However, political responsibilities in these fields are commonly fragmented and policy priorities misaligned. Providing warnings, information on risk areas or toolkits for climate health adaptation, digital climate health platforms may serve as a vehicle for better integration. The concept of policy coherence is relevant here, emphasizing the need for alignment between digital health initiatives and existing public health frameworks¹³. Policy coherence ensures that digital tools are not only technically effective, but also supported by the necessary institutional and policy environments¹⁴.

The development of the “AirRater app” in Australia is a successful practice in this field, as it managed to integrate air quality monitoring tools with public health policies². AirRater offers individual-level and location-specific data and assists public health responses to environmental hazards by providing timely, accessible, and understandable environmental information^4,25. It helps health departments communicate important information to populations, gather population-level health data during hazard events like smog or bushfires, and directly support individuals with personalized environmental information, thereby promoting improved health outcomes⁶.

Developers should closely collaborate with policymakers to align digital health tools with public health priorities. This requires an understanding of the policy landscape, identifying opportunities for integration, and advocating for the inclusion of digital tools in public health strategies. Ensuring that tools are adaptable to changing policy environments is critical for their long-term success.