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Learn more: PMC Disclaimer | PMC Copyright Notice J Clim Chang Health . 2026 Apr 6;27:100645. doi: 10.1016/j.joclim.2025.100645 Search in PMC Search in PubMed View in NLM Catalog Add to search Climate change and health in South Asia: A systematic mapping Inika Sharma Inika Sharma a Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India Find articles by Inika Sharma a , Bhanushree Soni Bhanushree Soni a Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India Find articles by Bhanushree Soni a , Manish Barik Manish Barik a Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India Find articles by Manish Barik a , Jyoti Tyagi Jyoti Tyagi a Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India Find articles by Jyoti Tyagi a , Samiksha Ingale Samiksha Ingale a Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India Find articles by Samiksha Ingale a , Chandni Singh Chandni Singh b School of Environment and Sustainability, Indian Institute for Human Settlements, Bangalore, India Find articles by Chandni Singh b , Gautam I Menon Gautam I Menon c Department of Physics and Trivedi School of Biosciences, Ashoka University, Sonepat, India d Centre for Climate Change and Sustainability, Ashoka University, Sonepat, India Find articles by Gautam I Menon c, d , Soumyadeep Bhaumik Soumyadeep Bhaumik a Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India e Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, University of New South Wales, Sydney, Australia Find articles by Soumyadeep Bhaumik a, e, ⁎ Author information Article notes Copyright and License information a Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India b School of Environment and Sustainability, Indian Institute for Human Settlements, Bangalore, India c Department of Physics and Trivedi School of Biosciences, Ashoka University, Sonepat, India d Centre for Climate Change and Sustainability, Ashoka University, Sonepat, India e Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, University of New South Wales, Sydney, Australia ⁎ Corresponding author at: Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India. [email protected] Received 2025 Feb 14; Accepted 2025 Dec 26; Collection date 2026 Jan-Feb. © 2025 The Author(s) This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). PMC Copyright notice PMCID: PMC13090525 PMID: 42005568 Abstract Introduction Climate change is a major threat to human health in South Asia. We mapped existing research on climate change and health in South Asia, identified research gaps, and developed a list of research questions (RQs) to inform a research priority setting (RPS) exercise. Methods We searched in 5 electronic databases for studies published after 2008, followed by screening and data extraction using standard evidence synthesis methods. We conducted a structured narrative synthesis and created evidence gap maps. We extracted RQs verbatim (or in their absence aims/objectives) and coded them to identify unique RQs. Results We retrieved 7273 records to include 308 studies from different countries in South Asia (Bangladesh -96, Bhutan - 4, India -142, Nepal -39, Pakistan - 46, and Sri Lanka - 13). They were categorized as research on: 1. health impacts of climate change (243, 78.90%), addressing 14 broader unique RQs and studying impact on 15 unique health conditions; 2. interventions to protect health from climate change (18, 5.84%), addressing 6 unique RQs; 3. climate change adaptation and mitigation efforts (40, 12.99%), addressing 9 unique RQs; 4. policy, governance, and decision-making tools (34, 11.04%), addressing 6 unique RQs; and 5. adaptation or development of tools and frameworks (9, 2.92%), addressing 3 unique RQs. Evidence gaps were also visualized. Conclusion To the best of our knowledge this is the first systematic map of this domain. We envisage this to facilitate future evidence synthesis and RPS in the region. Keywords: Climate change, Health, South Asia, Systematic mapping, Mitigation, Adaptation, Policy, India, Bhutan, Nepal, Bangladesh, Sri Lanka, Pakistan 1. Introduction The World Health Organisation (WHO) describes climate change as the “biggest threat to human health” [ 1 ]. Anthropogenic climate change is intensifying hazards and leading to increasing frequency and intensity of extreme weather events worldwide [ 2 ]. The WHO projects that climate change will cause 250,000 additional deaths annually between 2030 and 2050, with direct health costs rising to between 2 to 4 billion USD by 2030 [ 3 ]. Climate change is directly affecting ecosystem, water and food security, human settlements, and economies are also affected [ 4 ]. These indirectly affect human health, through altered vector transmission pathways, reduced agricultural yield, and reduced pollen production [ [5] , [6] , [7] ].Overall this leads to increased transmission of infectious disease, cardiovascular and respiratory diseases, mental health, nutrition, and overall mortality [ 8 ]. Understanding these risks is key to informing appropriate interventions, as well as adaptation and mitigation measures to protect health. South Asia, home to about a quarter of the human race, has high concentrations of vulnerable communities with significant resource limitations [ 9 , 10 ]. While research on climate change and health in the region has increased, there has been no systematic mapping of existing research in this domain. This study had the following goals: i. To map existing research on climate change and health in South Asia (Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka); ii. To develop a list of research questions (RQs) on which research on climate change and health in South Asia exists. This research is part of a broader study to set research priorities on climate change and heath in India. For a comprehensive mapping of relevant research, we considered the South Asia region, given regional similarities in climate vulnerabilities due to geographic proximity, shared socio-cultural history, development deficits, and similarities in health system designs. 2. Methods 2.1. Protocol and registration We registered the protocol a-priori in the OSF database ( https://osf.io/h87a2 ) [ 11 ]. We report the study following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews [ 12 ]. Compliance, using the PRISMA ScR checklist, is presented in Appendix A . 2.2. Eligibility criteria We included studies that met the following criteria: Concept: Studies on climate change related to human health. Studies which evaluated aspects of animals, plants, or environmental health along with human health also were included. Context: Studies conducted in South Asia; defined here as Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka. Multi-country studies beyond South Asia were included if disaggregated data were provided for at least one of these countries. Study design : Studies presenting any primary data (qualitative or quantitative), and modelling studies (that may have used secondary data). Year of publication: Studies published in, or after 2008. We chose 2008 as a cut-off as research in this domain came to focus primarily after the World Health Assembly resolution on climate change and health in 2008. 12 We excluded the following: Studies which solely focus on animal, plants or environmental health with no outcomes or health conditions/diseases related to human health are being investigated. Articles on non-climate hazards due to geological events (e.g. earthquakes) and non-anthropogenic climate change. 2.3. Information sources We searched multiple electronic databases (PubMed, EMBASE+EMBASE Classic, CINAHL-EBSCO, GreenFILE-EBSCO, and Women’s Studies International-EBSCO) for studies published between 2008-2024. The complete search strategy for all databases is available in Appendix B . In addition to database searches, we contacted relevant experts to identify any studies not captured. 2.4. Selection of sources of evidence We screened all retrieved records on Rayyan [ 13 ]. At least two independent reviewers (BS, JT, IS, MB, SI) screened first the title and abstracts, and then the full texts of studies for consideration of inclusion. In both screening stages, reviewers conducted regular meetings to resolve discrepancies and reach a consensus, with another reviewer (SB) acting as a mediator. 2.5. Data charting process and data items We charted the data using a customized data extraction form on Redcap 14.1, accessed through the George Institute’s REDCap platform ( https://redcap.georgeinstitute.org.in/ ) [ 14 ]. Data extraction was done by a single person with quality assurance through independent checks on 20% of data by a second person, and group consensus meetings. We extracted data on study authors, year of publication, study country(s), country affiliations of first and corresponding authors, study setting, study design, study aim, disease(s) studied, extreme weather events studied, equity focus/groups, study categories, outcomes measured, and funding and competing interests reported. Studies were marked as having an ‘equity focus’ if they exclusively sampled an equity population, reported disaggregated outcomes for equity groups, or had an equity-related objective. We extracted disease/health conditions based on reported outcomes or intervention targets; studies examining general symptoms (e.g. fever, motor skills) or all-cause mortality were classified as without specific disease focus. We assigned studies into the following categories (a single study could be grouped under multiple categories), based on their stated RQ/aims/objectives: • Category 1: Research on health impacts of climate change • Category 2: Research on interventions to protect health from climate change • Category 3: Research on climate change adaptation and mitigation efforts which target health risks specifically or as co-benefits • Category 4: Research on policy, governance, and decision-making tools for climate change and health • Category 5: Adaptation or development of tools and frameworks for any of the domains or sub-domains, listed above. Categories were pre-defined, prior to protocol development. They were adapted from the categorization for a similar evidence mapping in the 2021 WHO report of trends and gaps in climate and health research [ 15 ]. Modifications were done by consensus among the researchers with Category 4 being expanded to include policy/governance (including economic analysis), and Category 5 being added to identify methodological papers on the domain. 2.6. Synthesis of results We conducted a structured narrative synthesis of data overall, and category-wise, presenting summaries using descriptive statistics. To develop the list of RQs, we followed a three-step process. We first extracted verbatim information RQ/aims/objectives, as available. In the second step, if an RQ was explicitly stated, we extracted it verbatim and added it to our long list of questions. If the RQ was not explicitly stated, we extracted the aim/objectives and developed an RQ, ensuring it aligned with the stated objectives. In doing so, we also checked if the developed RQ aligned with the results reported. In the third step, we used the long list to develop a consolidated list of unique questions by combining similar RQs to generate broader, thematic questions. Three reviewers (IS, SB, BS) worked in collaboration in an iterative process in steps 2 and 3. In addition, we developed two evidence gap maps, one for category 1 studies, and one combined for category 2 and 3 studies. 2.7. Protocol deviations There were no deviations from the registered protocol. 2.8. Ethics approval No ethical approval was required for this study because it is a systematic mapping of existing studies and does not include any human or animal participants. 3. Results 3.1. Selection of studies We found 7,273 records through our database search and no new studies through contacting experts. Subsequent to duplicate removal and screening we included 308 studies which met our eligibility criteria. Reasons for exclusion at full-text level are presented in Appendix C . A PRISMA flowchart showing selection of studies is presented in Fig. 1 Fig. 1. Open in a new tab PRISMA flowchart for selection of studies. 3.2. Landscape of existing research on climate change and health in South Asia 3.2.1. Key characteristics of included studies The number of studies published year-on-year basis ( Fig. 2 ) increased by 2,200%, from 2 studies in 2008 to 46 studies in 2023. The increase has been consistent since 2017. Fig. 2. Open in a new tab Yearly publication trends. Most studies were conducted in India (142, 46.10%), followed by Bangladesh (96, 31.17%), Pakistan (46, 14.94%), Nepal (39, 12.66%), Sri Lanka (13, 4.22%), and Bhutan (4, 1.30%). The geographic distribution is displayed in Fig. 3 . There were only 14 studies that spanned more than one county in South Asia, of which 5 were modelling studies. Fig. 3. Open in a new tab Geographic distribution of studies. 3.2.2. Study designs The most common study design used was cross-sectional (99, 32.14%) followed by studies which modelled health impacts (61,19.81%), and ecological studies (57, 18.51%). Other study designs were mixed-methods studies (36, 11.69%), qualitative studies (28, 9.09%), cohort studies (10, 3.25%), case-control studies (6, 1.95%), quasi-experimental studies (5, 1.62%) and randomized controlled trials (4, 1.30%). 3.2.3. Funding status of studies Of the 308 studies, 197 (64%) reported funding, 45 (15%) reported no funding, and 66 (21%) did not report funding status, indicating suboptimal reporting practices. 3.2.4. Equity groups focus About half the studies (152, 49.35%) had an explicit equity group focus. Our results are visualized in Fig. 4 . Fig. 4. Open in a new tab Equity groups studied. ‘Other’ equity populations found included low-income groups (9, 5.92%), pilgrims (1, 0.66%), religious minorities (4, 2.63%), ethnic minorities, individuals with physical or mental disabilities (1, 0.66%), outdoor workers (multiple occupations) (1, 0.66%), lactating women (1, 0.66%), and post-natal mothers (1, 0.66%). 3.2.5. Disease focus There were 96 (31.17%) studies which did not have a disease focus, with 212 studies examining one or multiple diseases. Among these, the neglected tropical diseases and malaria (65, 30.66%), and enteric infections (55, 25.94%), were most studied. Disease representations and categorizations are reported in Table 1 . Table 1. Diseases studied. Condition Type Number of studies (n=212) Percentage COMMUNICABLE DISEASES Neglected tropical diseases and malaria 65 30.66% Enteric infections 55 25.94% Respiratory infections and tuberculosis 39 18.40% HIV/AIDS and sexually transmitted infections 0 0% Other infectious diseases 17 8.02% NON-COMMUNICABLE DISEASES Nutritional deficiencies 29 13.67% Cardiovascular diseases 25 11.79% Skin and subcutaneous diseases 21 9.91% Diabetes and kidney diseases 12 5.66% Sense organ diseases 12 5.66% Maternal and neonatal disorders 11 5.19% Neurological disorders 10 5.19% Chronic respiratory diseases 9 4.25% Digestive diseases 9 4.25% Musculoskeletal disorders 8 3.77% Neoplasms 3 1.42% Self-harm and interpersonal violence 7 3.30% Unintentional injuries 21 9.91% Heat-related illnesses 29 13.67% Mental disorders 18 8.49% Substance use disorders 2 0.94% Other non-communicable disorders 12 5.66% Open in a new tab 3.2.6. Extreme weather events There were 159 (51.62%) studies that focused on one or more extreme weather events. The extreme weather events extraction did not include slow-onset events (such as soil and water salinity). Floods (71, 44.65%), heat waves (46, 28.93%), tropical cyclones (46, 28.93%), and drought (41, 25.79%) were the most common extreme weather events studied. Our results are visualized in Fig. 5 . Fig. 5. Open in a new tab Extreme weather events studied. ‘Other’ events included cloud bursts, storm surges, tornadoes, thunderstorms, windstorms, snowstorms, hailstorms, avalanches, landslides, lightning strikes, and smog; that were explicitly linked to climate change by the authors. 3.2.7. Categories of study in climate change and health in South Asia Studies were categorized as: • Category 1 (243, 78.90%): Research on health impacts of climate change. • Category 2 (18, 5.84%): Research on interventions to protect health from climate change. • Category 3 (40, 2.99%): Research on climate change adaptation and mitigation efforts which target health risks specifically or as co-benefits. • Category 4 (34, 11.04%): Research on policy, governance, and decision-making tools for climate change and health. • Category 5 (9, 2.92%): Adaptation or development of tools and frameworks for any of the domains or sub-domains, listed above. There were 36 studies categorized in more than one category. Appendix D includes a pairwise matrix showing the number of studies across multiple categories. The long list of verbatim aims/objectives and consolidated questions are additionally reported ( Appendix D ). We developed evidence gap maps using EPPI-Mapper [ 16 , 17 ] . The interactive version of these maps include details for study categories and outcomes, and are available online at https://info.georgeinstitute.org.in/EGMP_1-3_CCHSAM.html . 3.2.7.1. Category 1: Research on health impacts of climate change The majority (243, 78.90%) of studies were categorized as research on the health impacts of climate change. Among these, 124 (51.03%) studied the effect of climate change-related weather variability, 120 (49.38%) were on effects of extreme weather events projected to increase in frequency/severity due to climate change, and 74 (30.45%) dealt with the effects of climate change/greenhouse gas emissions. There were 113 (46.50%) category 1 studies conducted in India, with 80 (32.92%) in Bangladesh, 30 (12.35%) in Pakistan, 26 (10.70%) in Nepal, 9 (3.70%) in Sri Lanka and 3 (1.23%) conducted in Bhutan. The evidence gap map is visualized in Fig. 6 . Disease prevalence/incidence health outcomes were most frequently measured across category 1 studies. Despite all studies having measured the impact of climate change on one or more health outcomes, there was a markedly low number of studies that measured impact on quality of life (n=2, 0.82%). Additionally, relatively few studies on climate change impacts on health measured outcomes related to human migration/ displacement (26, 10.70%); sense of identity, culture, social capital, or community cohesion (18, 6;59%); education and skills outcomes (13, 5.35%); and rights and empowerment (2, 0.82%). Fig. 6. Open in a new tab Outcomes measured in category 1. This gap map demonstrates the number of studies measuring specific outcomes (columns) across study categories (rows). Bubble size is proportional to the number of studies. The empty cells indicate gaps in research- where no included studies measured those outcomes. The studies broadlyaddressed the following RQs: 1. What are the impacts of extreme temperature events on health? 2. What are the impacts of water-related extreme events on health? 3. How does climate change impact the health and socio-economic conditions of coastal, island, and riverine populations? 4. How does climate change impact health systems? 5. How does climate change worsen inequities in health? 6. How is climate vulnerability different in different regions/populations? 7. How does climate change influence migration and migrant health? 8. How does climate change impact the livelihood and health of workers? 9. What is the effect of climate change on food security? 10. What is the effect of climate change on (re)emergence of zoonotic diseases? 11. What is the impact of simultaneous occurrence of climatic hazards and disease outbreaks on health, health service delivery, and disaster response? 12. How do climate change and air pollution interact to effect health? 13. How does climate change impact mortality, life expectancy and Disability-Adjusted Life Years across different populations? 3.2.7.2. Category 2: Research on interventions to protect health from climate change There were 18 studies on interventions to protect health from climate change: 10 (55.56%) studies on understanding or improving health systems resilience to changing climate, and 9 (50.00%) on other interventions to protect health from climate change. In this category, 6 (33.33%) studies were conducted in India, 5 (27.78%) in Bangladesh, 4 (22.22%) in Pakistan, 2 (11.11%) in Nepal, 1 (5.56%) in Sri Lanka and none in Bhutan. The evidence gap map for Category 2 studies is presented along with that of Category 3 studies in Fig. 7 . Notably, none of the studies measured mental health symptoms, quality of life, rights and empowerment outcomes or identity/cultural outcomes. In the studies on interventions to improve health system resilience, impacts on health outcomes aside from incidence/prevalence of diseases were not measured. Fig. 7. Open in a new tab This gap map demonstrates the number of studies measuring specific outcomes (columns) across study categories (rows). Bubble size is proportional to the number of studies. The empty cells indicate gaps in research- where no included studies measured those outcomes. The studies broadly addressed the following RQs: 1. How can we improve health system resilience to climate change? 2. What is the effectiveness of health promotion interventions to protect health from climate change? 3. What is the role of traditional medicine in managing the effects of climate change on health? 4. How can climate change related nutritional and food security concerns be addressed? 5. What is the effectiveness of workplace strategies/programs to protect the health of workers during heat waves? 6. What strategies/programs work best to protect health from climate change, from an equity standpoint? In this category, specific interventions studied within RQs included ward relocation, passive cooling strategies (rooftop retrofits), Heat Emergency Awareness & Treatment (HEAT) intervention, prehospital acute health illness diagnosis, micronutrient powder programs, humanitarian aid, community health worker led programs, and educational manuals. Further details are reported in Appendix D . 3.2.7.3. Category 3: Research on climate change adaptation and mitigation efforts which target health risks specifically or as co-benefits There were 40 studies that examined climate change adaptation and mitigation efforts. Of these studies 19 (47.50%) were conducted in India, 10 (25.00%) in Pakistan, 9 (22.50%) in Bangladesh, 6 (15.00%) in Nepal, 2 (5.00%) in Sri Lanka and no studies were conducted in Bhutan. The evidence gap map for Category 3 studies is presented along with that of Category 2 studies in Fig. 7 . There were no studies that measured quality of life, or rights and empowerment outcomes. The studies in this category addressed these broader RQs: 1. What is the effectiveness of community-based adaptation programs in terms of health co-benefits? 2. What climate adaptation efforts can protect the health of cyclone-affected communities? 3. What is the impact of agricultural adaptation strategies on the health and livelihood of farming communities? 4. What are the costs of various climate change adaptation and mitigation efforts, and are they cost-effective given their impact on health? 5. How can traditional knowledge systems inform adaptation and mitigation strategies to protect health? 6. What is the effectiveness of interventions for ensuring safe, sustainable water supplies in communities facing climate-induced water scarcity? 7. What mitigation and adaptation measures are effective in protecting food security? 8. How can urban planning help reduce health risks from climate change? 9. What are the health effects of strategies to decrease air pollution? In category 3, most studies investigated which adaptation and mitigation strategies were used. Where there was a focus on specific strategies within RQs, these included, mangrove forests, point-of-use household water treatment devices, health action plans, renewable energy use, trade integration, and human capital development. Further details are reported in Appendix D . 3.2.7.4. Category 4: Research on policy, governance, and decision-making tools for climate change and health There were 34 (11.04%) studies which researched policy, governance and decision-making for climate change and health. There were 19 (55.88%) studies conducted in India, 7 (20.59%) in Bangladesh, 7 (20.59%) in Nepal, and 6 (17.65%) in Pakistan. One (2.94%) study each was conducted in Sri Lanka and Bhutan. In this category, 21 (61.76%) studies were conducted on policy research, and 13 (38.24 on "other topics”. These other topics included decision-making tools (e.g. vulnerability assessment tools), barriers to research, sectoral interventions, adaptive governance choices, power in governance/institutions, and approaches for public health surveillance. Category 4 studies broadly covered the following RQs: 1. What is the effectiveness (actual or projected) of different climate change policies and commitments on health, environment, and economy? 2. How can we better integrate data on climate vulnerability for decision making? 3. How can multi-sectoral action for climate mitigation and adaptation for health be better integrated into existing policies? 4. What accountability frameworks and governance structures can ensure better management of the health risks of climate change at various levels? 5. How are climate change and health policy agendas developed, influenced, and prioritized? 6. What are the barriers and enablers to conducting research on climate change and health? 3.2.7.5. Category 5: Adaptation or development of tools and frameworks for any of the domains or sub-domains, listed above There were 9 (2.92%) studies conducted in this category. Of these, 6 (66.67%) studies were conducted in India, 3 (3.33%) in Pakistan, 2 (2.22%) in Nepal, and 2 (2.22%) in Bangladesh. There were no studies conducted in Bhutan and Sri Lanka. Studies broadly covered the following RQs: 1. Development of various vulnerability indices relevant to climate change and health 2. Development of conceptual frameworks and tools to measure the effect of climate change adaptation and mitigation responses on health 3. Development of a framework on characteristics of climate adaptation policies. 4. Discussion 4.1. Summary of key findings We mapped 308 studies on climate change and health in South Asia. Most existing research focusses on understanding the impacts of climate change on health, with research on finding solutions (health interventions or adaptation/mitigation measures), policy and governance related research, and methodological research remaining as gaps. We demonstrated research gaps across categories through evidence gap maps. Since 2008, the number of studies has increased. India accounted for the largest share (46%), while Bhutan had only four studies. Only 14 studies involved multiple countries, demonstrating negligible regional scientific cooperation. Most studies had a specific disease focus, but there was no or minimal research on sexually transmitted infections, neoplasms and substance use disorders. Almost half the studies had an equity focus, but not all equity aspects were adequately covered. 4.2. Study findings in broader context We found that research on climate change and health in South Asia remains heavily focussed on health impacts, with health interventions to protect against climate change (only 18 studies) remaining neglected. Research focussing on strengthening health system resilience without reinforcing power imbalances should be prioritized [ 18 ]. Our findings are similar to global trends identified by the WHO, which in 2021 found a dearth of research on health protection strategies and adaptation/mitigation measures [ 15 ]. Disease incidence and prevalence were the most studied outcomes, while quality of life was largely neglected, measured in only two studies. There was limited research on social determinants of health and outcomes like rights and empowerment (n=2), education, and skills (n=18). Considering the centrality of the connections between empowerment, education, equity and health, these outcomes warrant greater consideration in future research. The most studied health conditions were reflective of the diseases most associated with climate change - neglected tropical diseases and malaria, enteric infections, respiratory infections, nutritional deficiencies, and heat-related illnesses. This trend is also present in global climate change and health research [ 19 ]. There were no studies on sexually transmitted infections (STIs). This gap requires more attention, with a previous global scoping review showing that extreme weather events can increase the prevalence of HIV and gender-based violence, as well as worsen health outcomes through reduced access to testing and treatment [ 20 ]. Children and adolescents (n=64), and rural/remote residents (n=58) were the most studied equity groups. The focus on children, with 21 studies on childhood nutrition, mirrors the emphasis on child health, safety and nutrition in the 2030 Sustainable Development Goals [ 21 ]. However, climate change exacerbates inequities [ 22 ], and representation of other equity groups including migrants, elderly people, pregnant women, and slum residents was low. No studies focused on LGBTGIA+ groups, so it is unclear what unique health challenges they may face in the context of climate change in South Asia, especially since they are more likely to experience stigma, discrimination, and intersectional barriers to healthcare utilization [ 22 , 23 ]. Similarly, there were only 4 studies focused on Adivasi/Tribal populations. This result, however, demonstrates a limitation in our search. A 2020 evidence mapping of Tribal knowledge of climate change adaptation (not focussed on health), found India had the most publications globally, at 23 studies [ 24 ]. Though most of the studies were not related to health, 3 could have met our eligibility criteria [ [25] , [26] , [27] ]. Regardless, there were no overlaps in included Indian studies between the two mappings. This suggests that our search strategy was not exhaustive for this domain, despite using multiple databases. On the other hand, both mappings retrieved minimal studies on climate change and Tribal health, identifying this as a research gap. Tribal populations face increased vulnerability to climatic and non-climatic risks, and there is wide acknowledgement that climate change adaptation can be enhanced through integration of Indigenous knowledge [ 28 ]. Finally, regional risks associated with climate change need to be understood for the development of appropriate adaptation measures [ 15 ]. Only 4 studies were conducted in Bhutan. Although Bhutan has the smallest population among the included countries and acts as a net carbon sink globally, it is geographically vulnerable to extreme weather events such as glacial lake outburst floods and forest fires [ 29 ]. Key implications of our study on existing research are presented in Table 2 . Table 2. Implications for future research and funding. 1. Funding for research on solutions to minimize the health impacts of climate change is a gap. Routine measurement of health outcomes and co-benefits in climate adaptation and mitigation measures can guide the ongoing responses to climate change. 2. There is a need for research to focus on those equity groups which are most vulnerable, or which may not have been focused so far (i.e. migrants, urban slum people, Adivasi/Tribal people, LGBTQIA+ people). More research is required on specific regional climate change vulnerabilities, such as glacial lake bursts, which remain a risk in Bhutan, Nepal, Pakistan and parts of India. 3. An overwhelming large amount (78.90%) of existing research is on the effects of climate change on health, many of them are either modelling studies or cross-sectional in nature. Epidemiological studies are foundation of action, but there is a need to fund cohort studies. More research is required on neglected health effects such as sexual health. 4. There is scope for future research on climate change and health to explore the pathways to impact and directional influence on factors including empowerment, education and social cohesion. 5. Government bodies and funding calls should prioritize research on the development and implementation of climate change and health policies at different levels of governance, particularly in countries such as Bhutan and Sri Lanka where minimal research exists in this domain. 6. There is a need for funding and funding mechanisms that can enable trans-national research in climate change and health in the South-Asia region, given that watersheds and airsheds are shared between India, Pakistan, and Bangladesh. 7. Methodological research, and meta-research for the development of tools/frameworks, and their adaption in South Asian context might be a priority focus considering their ripple effect on all other aspects of research. Open in a new tab 4.3. Strengths and limitations Our search covered multiple databases (PubMed, EMBASE+EMBASE Classic, CINAHL-EBSCO, GreenFILE-EBSCO, and Women’s Studies International-EBSCO), without any restrictions on language. We deliberately selected this combination of databases to ensure a strong coverage of biomedical and clinical research (PubMed, EMBASE), nursing and allied health literature (CINAHL), environmental science (GreenFILE), and gender-related perspectives (Women’s Studies International), all of which are critical for understanding the multifaceted nature of climate change and health research. However, we did not search in Scopus, an interdisciplinary database which is known to have good coverage of policy and social aspects of health. Its exclusion may have resulted in missing studies from journals such as the Journal of Climate Change and Health which has a specific focus on climate change and health and aims to bridge many of the research gaps we highlighted. We believe this omission does not change the overall assessment, or the broader patterns identified, but future reviews should include Scopus to enhance comprehensiveness. We followed standard and robust systematic mapping methods and reported results according to the PRISMA-ScR guidelines. Two authors independently screened texts for eligibility during abstract and full-text screening to minimize bias and errors. As data extraction was not done in duplicate, we used thorough quality check procedures. Due to the use of ambiguous terms in the reporting of some included studies, we acknowledge some challenges in categorizing outcomes. Despite this, we made decisions on this through consensus and maintained consistency across the project. While air pollution is widely examined in environmental health research, our review excluded air-pollution related studies unless directly linked to greenhouse emissions or climate change mitigation scenarios. Similarly, during screening, we encountered studies on disaster. Our inclusion criteria required that studies explicitly frame their investigation within the context of climate change and human health. This approach ensured consistency in interpretation of eligibility criteria across reviewers and ensures included studies were aligned well with our study objectives. As an example, during screening it became apparent that the distinctions between extreme weather events caused by climate change, and those that may not have been linked to climate change (e.g. monsoon flooding), was not always evidently clear. Complete separation between these events is not feasible [ 30 ]. We acknowledge that this pragmatic decision may have excluded studies on disaster which might provide empirical entry points relevant to climate-sensitive health outcomes but did not explicitly mention or framed their research around climate change terminology. We identify this as a methodological gap for evidence synthesis on the effects of climate change on health, for which guidance needs to be developed. Additionally, we also recognize that the temporal framing of included studies varied considerably, with some focussing on short-term events and others examining longer-term climatic trends. The current study did not intend to analyze this heterogeneity, as we only aimed to systematically map the primary studies. 5. Conclusion This systematic mapping of research conducted in climate change and health in South Asia presents topics that have previously been researched, and highlights gaps and opportunities for future research. Although the number of studies conducted has been increasing over the years, further research is required to understand underrepresented climate change topics and effects on vulnerable populations. Some of the topics requiring further research include LGBTQIA+ health, health of Tribal populations, climate change and health in Bhutan, and impacts on quality of life, education and empowerment outcomes. While significant research has been undertaken on the health impacts of climate change, more is needed on examining the effectiveness of health interventions to protect against climate change. These gaps reveal the importance of research that examines local/regional climate change concerns with emphasis on disenfranchised and minority groups. Researchers, institutions and governing bodies need to adopt grounded equity/justice lens when studying climate change and health, and when developing related policies. CRediT authorship contribution statement Inika Sharma: Writing – review & editing, Writing – original draft, Visualization, Validation, Project administration, Data curation. Bhanushree Soni: Writing – review & editing, Validation, Formal analysis, Conceptualization. Manish Barik: Writing – review & editing, Validation, Data curation. Jyoti Tyagi: Writing – review & editing, Validation, Investigation, Data curation. Samiksha Ingale: Writing – review & editing, Validation, Investigation, Data curation. Chandni Singh: Writing – review & editing, Validation. Gautam I. Menon: Writing – review & editing, Validation. Soumyadeep Bhaumik: Writing – review & editing, Validation, Supervision, Resources, Methodology, Investigation, Conceptualization. Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Acknowledgements We acknowledge Dr Shridhar Kadam [Indian Institute of Public Health -Bhubaneswar] and Dr Devarsetty Praveen [George Institute for Global Health, India], who were part of the steering committee of the research priority setting exercise to which this study contributes to. Dr Chandni Singh, and Prof Gautam I. Menon are also part of the steering committee. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Footnotes Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.joclim.2025.100645 . Appendix. Supplementary materials mmc1.pdf (1.2MB, pdf) References 1. Ghebreyesus T.A., Al Jaber S.A., Kerry V. World Health Organization; Geneva (CH): 2025. We must fight one of the world’s biggest health threats: climate change. https://www.who.int/news-room/commentaries/detail/we-must-fight-one-of-the-world-s-biggest-health-threats-climate-change WHO[cited 2025 Jan 27]. Available from. [ Google Scholar ] 2. Pörtner H.-O., Roberts D.C., Adams H., Adelekan I., Adler C., Adrian R., et al. In: Sixth assessment report of the intergovernmental panel on climate change. Masson-Delmotte V., Zhai P., Pirani A., Connors S., Péan C., Berger S., et al., editors. IPCC; Geneva (CH): 2022. Technical summary; pp. 37–118. https://www.ipcc.ch/report/ar5/wg1/technical-summary/ editors. Available from. [ Google Scholar ] 3. World Health Organisation . WHO; Geneva (CH): 2023. Climate change fact sheet. https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health [cited 2025 Jan 27. Available from. [ Google Scholar ] 4. Intergovernmental Panel on Climate Change . In: Climate change 2023: synthesis report. contribution of working groups I, II and III to the sixth assessment report of the intergovernmental panel on climate change. Lee H., Romero J., editors. IPCC; Geneva (CH): 2023. Core Writing Team. [Core Writing Team editors][cited 2025 Jan 27]. [ DOI ] [ Google Scholar ] 5. Mora C., McKenzie T., Gaw I.M., Dean J.M., von Hammerstein H., Knudson T.A., et al. Over half of known human pathogenic diseases can be aggravated by climate change. Nat Clim Change. 2022;12(9):869–875. doi: 10.1038/s41558-022-01426-1. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 6. Lesk C., Anderson W., Rigden A., Coast O., Jägermeyr J., McDermid S., et al. Compound heat and moisture extreme impacts on global crop yields under climate change. Nat Rev Earth Environ. 2022;3(12):872–889. doi: 10.1038/s43017-022-00368-8. [ DOI ] [ Google Scholar ] 7. World Health Organization Regional Office for Europe. Climate change and health: fact sheet on Sustainable Development Goals (SDGs): health targets. World Health Organization. Copenhagen (DK): WHO; 2018 [cited 2025 Jan 27]. Available from: https://www.who.int/europe/publications/i/item/WHO-EURO-2018-2374-42129-58024 . 8. McMichael A.J., Lindgren E. Climate change: present and future risks to health, and necessary responses. J Intern Med. 2011;270(5):401–413. doi: 10.1111/j.1365-2796.2011.02415.x. [ DOI ] [ PubMed ] [ Google Scholar ] 9. Shaw R., Luo Y., Cheong T.S., Halim S.A., Chaturvedi S., Hashizume M., et al. In: Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Pörtner H-O, Roberts D.C., Tignor M., Poloczanska E.S., Mintenbeck K., Alegría A., et al., editors. Cambridge University Press; Cambridge (UK) and New York (NY): 2022. Climate change 2022: impacts, adaptation and vulnerability; pp. 1457–1579. https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter10.pdf Asia. Available from. [ Google Scholar ] 10. Eckstein D., Künzel V., Schäfer L. Germanwatch; Bonn (DE): 2021. The global climate risk index 2021: who suffers most from extreme weather events? Weatherrelated loss events in 2019 and 2000–2019. [ Google Scholar ] 11. Tyagi J., Buse K., Sharma I., Barik M., Bhaumik S. Center for Open Science; Charlottesville (VA): 2024. Climate change and human health in South Asia: systematic mapping and evidence gap map to inform research priority-setting exercise. Open Science Framework. https://osf.io/h87a2 [cited 2025 Feb 15]. Available from. [ Google Scholar ] 12. Tricco A.C., Lillie E., Zarin W., O'Brien K.K., Colquhoun H., Levac D., et al. Prisma extension for scoping reviews (prisma-scr): checklist and explanation. Ann Intern Med. 2018;169(7):467–473. doi: 10.7326/M18-0850. [ DOI ] [ PubMed ] [ Google Scholar ] 13. Ouzzani M., Hammady H., Fedorowicz Z., Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016:51. doi: 10.1186/s13643-016-0384-4. -10. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 14. Harris P.A., Taylor R., Minor B.L., Elliott V., Fernandez M., O'Neal L., et al. The redcap consortium: building an international community of software platform partners. J Biomed Inform. 2019 doi: 10.1016/j.jbi.2019.103208. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 15. World Health Organization . World Health Organization; Geneva (CH): 2021. Climate change and health research: current trends, gaps and perspectives for the future. https://cdn.who.int/media/docs/default-source/climate-change/cop26/final_cop26-research-web.pdf?sfvrsn=e8fb5dcb_5&download=true WHO[cited 2025 Jan 27]. Available from. [ Google Scholar ] 16. Thomas J., Graziosi S., Brunton J., Ghouze Z., O’Driscoll P., Bond M., et al. EPPI-reviewer: advanced software for systematic reviews, maps and evidence synthesis. London: EPPI Centre, UCL Social Research Institute, University College London; 2023. 17. Digital Solution Foundry, EPPI Centre. Eppi-Mapper, Version 2.2.4. London (UK): EPPI Centre, UCL Social Research Institute, University College London; 2023. Internet. [cited 2025 Jan 27]. Available from: https://eppi.ioe.ac.uk/cms/Research/Eppi-Mapper.aspx . 18. Witter S., Thomas S., Topp S.M., Barasa E., Chopra M., Cobos D., et al. Health system resilience: a critical review and reconceptualisation. Lancet Glob Health. 2023;11(9):e1454. doi: 10.1016/S2214-109X(23)00279-6. -e8. [ DOI ] [ PubMed ] [ Google Scholar ] 19. Rocque R.J., Beaudoin C., Ndjaboue R., Cameron L., Poirier-Bergeron L., Poulin-Rheault R.A., et al. Health effects of climate change: an overview of systematic reviews. BMJ Open. 2021;11(6) doi: 10.1136/bmjopen-2020-046333. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 20. Logie C.H., Toccalino D., MacKenzie F., Hasham A., Narasimhan M., Donkers H., et al. Associations between climate change-related factors and sexual health: a scoping review. Glob Public Health. 2024;19(1) doi: 10.1080/17441692.2023.2299718. [ DOI ] [ PubMed ] [ Google Scholar ] 21. United Nations General Assembly . United Nations; New York (NY): 2015. Transforming our world: the 2030 agenda for sustainable development. https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustainable%20Development%20web.pdf?ref [cited 2025 Jan 27]. Available from. [ Google Scholar ] 22. Macapagal K., Bhatia R., Greene GJ. Differences in healthcare access, use, and experiences within a community sample of racially diverse lesbian, gay, bisexual, transgender, and questioning emerging adults. LGBT Health. 2016;3(6):434–442. doi: 10.1089/lgbt.2015.0124. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 23. Giri P.D., Adhikari A., Pradhan M., Yogi I., Khanal S. Barriers in access to health care services among lesbian, gay, bisexual, transgender (LGBT) Int J New Technol Res. 2019;5(3):15–20. [ Google Scholar ] 24. Petzold J., Andrews N., Ford J.D., Hedemann C., Postigo JC. Indigenous knowledge on climate change adaptation: a global evidence map of academic literature. Environ Res Lett. 2020;15(11) [ Google Scholar ] 25. Hazarika N., Tayeng T., Das AK. Living in troubled waters: stakeholders’ perception, susceptibility and adaptations to flooding in the upper Brahmaputra plain. Nat Hazards. 2016:831157–831176. doi: 10.1007/s11069-016-2366-1. [ DOI ] [ Google Scholar ] 26. Joshi V., Rawat M., Sharma A., Kumar K., Panda A. Traditional knowledge of natural disaster mitigation and ethno medicine practices in Himalaya with special reference to Sikkim. Indian J Tradit Knowl. 2011 [ Google Scholar ] 27. Tiwari P.C., Joshi B. Changing monsoon pattern and its impact on water resources in Himalaya: responses and adaptation. In: Climate Adaptation Futures. 2013. p.301-7. doi:10.1002/9781118529577.ch29 . 28. Makondo C.C., Thomas DS. Climate change adaptation: linking indigenous knowledge with western science for effective adaptation. Environ Sci Policy. 2018:8883–8891. doi: 10.1016/j.envsci.2018.06.014. [ DOI ] [ Google Scholar ] 29. World Health Organization . World Health Organization; Bhutan. Geneva (CH): 2016. Climate and health and country profile — 2015. https://www.who.int/publications/i/item/WHO-FWC-PHE-EPE-15.17 [cited 2025 Jan 27]Available from. [ Google Scholar ] 30. Lavell A., Oppenheimer M., Diop C., Hess J., Lempert R., Li J., et al. Managing the risks of extreme events and disasters to advance climate change adaptation: a special report of Working Groups I and II of the Intergovernmental Panel on Climate Change. Geneva (CH): IPCC; 2012. [cited 2025 Jan 27]. Available from: https://www.ipcc.ch/report/managing-the-risks-of-extreme-events-and-disasters-to-advance-climate-change-adaptation/ . 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