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Article(id=1320438118088557152, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320438090615862080, articleNumber=null, orderNo=null, doi=10.11847/zgggws1147334, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1741276800000, receivedDateStr=2025-03-07, revisedDate=1756828800000, revisedDateStr=2025-09-03, acceptedDate=1768579200000, acceptedDateStr=2026-01-17, onlineDate=1792746579905, onlineDateStr=2026-10-23, pubDate=1775750400000, pubDateStr=2026-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792746579905, onlineIssueDateStr=2026-10-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792746579905, creator=13701087609, updateTime=1792746579905, updator=13701087609, issue=Issue{id=1320438090615862080, tenantId=1146029695717560320, journalId=1319373219989389464, year='2026', volume='42', issue='4', pageStart='385', pageEnd='512', issueExtLink='null', onlineDate='null', pubDate='1775750400000', pubDateStr='2026-04-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792746573356, creator='13701087609', updateTime=1792748076043, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1320444393430040620, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320438090615862080, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1320444393430040621, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320438090615862080, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=479, endPage=487, ext={EN=ArticleExt(id=1320438118264717921, articleId=1320438118088557152, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Global application of WHO′s building and measurement tools for climate-resilient health systems and its implications for China, columnId=1320427713148597230, journalTitle=Chinese Journal of Public Health, columnName=Review, runingTitle=null, highlight=null, articleAbstract=
Objective

To summarize WHO′s building and measurement tools for climate-resilient health systems (CRHS), analyze their global application status and applications strategies in different countries, and inform China′s CRHS development.

Methods

The related literature including policies or studies published in English or Chinese before December 2024 was comprehensively searched against the Web of Science, WHO Library, government publications of different countries, reports, official websites of health departments and relevant authorities, other international organizations′ official websites, and Google Scholar. After rigorous screening, 10 WHO-aligned national government reports/action plans were included for in-depth analysis.

Results

Globally, high-income countries such as Canada and climate-sensitive nations such as Bangladesh have applied these tools. The strategies adopted by countries primarily focused on policy integration, international cooperation, phased implementation, and localization. China′s CRHS development still faces challenges, especially in the health talent domain. Accordingly, China needs strengthened health workforce development and context-specific adaptation of tools.

Conclusions

WHO tools provide vital guidance for building CRHS. Countries should adapt them contextually to enhance CRHS resilience.

, authors=Yang HAO1, Na LI1, Minghui REN1, 2, 3, 4, 5, authorsList=Yang HAO, Na LI, Minghui REN, authorCompany=null, correspAuthors=Minghui REN, authorNote=null, correspAuthorsNote=
REN Minghui, E-mail:
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目的

旨在系统性地总结和介绍WHO发布的卫生体系气候韧性建设与评估工具，深入分析其在全球的应用现状及各国应用策略，并为中国气候韧性卫生体系建设提供借鉴。

方法

采用系统性综述方法，于2024年12月1日至12月31日对Web of Science、WHO图书馆数据库、各国政府出版物、报告、卫生部门及相关主管部门官方网站、其他国际组织官方网站以及Google Scholar进行了2024年12月以前以英文或中文发表的政策或研究进行全面检索。经严格筛选，最终对纳入的10篇参考WHO相关文件的国家政府工作报告与行动方案进行深入分析。

结果

全球范围内，包括加拿大等高收入国家，以及孟加拉国等气候敏感型国家已参考应用。各国应用策略主要集中在政策嵌入、国际合作与联盟、渐进式执行以及本地化等方式。研究发现，中国在气候韧性卫生体系建设中，卫生人力领域建设有待进一步加强，且需合理借鉴各国的成功经验与策略，结合国情进行指标筛选、调整及更新。

结论

WHO的工具为全球卫生体系气候韧性建设提供了科学指导框架。各国应根据自身情况合理应用，以提升卫生体系的气候韧性。

, authors=郝洋1, 李娜1, 任明辉1, 2, 3, 4, 5, *, *, authorsList=郝洋, 李娜, 任明辉, authorCompany=null, correspAuthors=任明辉, authorNote=

郝洋（2004—），本科在读，研究方向：全球卫生外交及卫生治理

, correspAuthorsNote=
任明辉，E-mail：
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郝洋（2004—），本科在读，研究方向：全球卫生外交及卫生治理

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National health and climate strategy[EB/OL]. 2023[2024-12-18]. https://www.health.gov.au/our-work/national-health-and-climate-strategy., articleTitle=null, refAbstract=null), Reference(id=1320438127441855158, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320438118088557152, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=18, rfOrder=17, authorNames=null, journalName=null, refType=null, unstructuredReference=Hoeben A D, Otto I M, Chersich M F. Integrating public health in European climate change adaptation policy and planning[J]. 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International Journal of Environmental Research and Public Health, 2018, 15(9): 1943., articleTitle=null, refAbstract=null), Reference(id=1320438127592850104, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320438118088557152, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=20, rfOrder=19, authorNames=null, journalName=null, refType=null, unstructuredReference=Alruwaili, Abdulrahman M, et al. Implementing sustainable practices in healthcare facilities to enhance environmental health[J]. Chelonian Research Foundation, 17(2), 1252–1259., articleTitle=null, refAbstract=null), Reference(id=1320438127680930489, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320438118088557152, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=21, rfOrder=20, authorNames=null, journalName=null, refType=null, unstructuredReference=杨廉平, 廖文敏, 钟爽, 等. 医疗卫生人员对气候变化的健康风险认知和适应策略研究进展[J]. 环境与职业医学, 2020, 37(1): 23-29., articleTitle=null, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1320438119573340781, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320438118088557152, xref=1, ext=[AuthorCompanyExt(id=1320438119581729390, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320438118088557152, companyId=1320438119573340781, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, 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注：“√”表示该国家选择利用该组件该指标；“×”表示该国家没有选择利用该组件该指标。

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Application of Operational Framework for Building Climate-Resilient Health Systems in different countries

, figureFileSmall=null, figureFileBig=null, tableContent=
文件名称时间发布部门应用情况
加拿大人群健康与气候变化：为行动增进我们的知识[8]2022加拿大卫生部借鉴WHO操作框架思路和组成部分，选取各部分可测量结果示例系统性评估了气候变化对不同人群的健康影响，并在领导力与治理、基础设施与技术等重点领域提出具体措施。
报告通过“先研究评估—再试点推广—最后全国实施”的方式，确保政策循序渐进地落地，提高执行的可行性和有效性。
孟加拉国卫生：国家适应计划[9]2018孟加拉人民共和国政府卫生和家庭福利部卫生服务总局
以操作框架的10个组成部分为基础，根据框架给出的战略目标对现状进行分析，提出水资源安全等主要障碍和适应方案，提出后续行动计划，指出将建设气候韧性策略与现有的卫生政策框架结合。同时列出对行动计划和预期可交付成果的监测和评价计划，包括指标、基线、核查手段、报告频率和责任机构。
在低收入和中等收入国家背景下建立和
加强适应气候变化的卫生系统[10]		2024挪威发展合作署框架指导在中低收入国家应从减少现有卫生系统脆弱性开始建立自身卫生体系的气候韧性。凭借框架提出的6个组成部分以理解和分类与卫生体系气候韧性有关的发现，进而参考此框架确定该研究领域需要进一步调查内容：可持续的融资、弱势群体、在现实环境中实施气候适应战略等。
加纳国家气候变化总体规划：
2015—2020年执行行动方案[11]		2015加纳国家气候变化委员会（NCCC）
加纳共和国环境、科学、技术和创新部		该行动计划参考框架，在框架所提出的卫生体系的组成部分领域针对气候韧性加强国家行为，特别针对气候变化影响评估和健康影响监测部分，并在每一个领域详细列出了行动目标、时间安排等。
气候综合医疗战略[12]2024奥地利联邦社会事务、卫生、护理和消费者保护部承诺参考建立气候韧性医疗系统的10个关键维度，用于指导奥地利医疗系统的结构调整与发展，制定具体措施和指标。
2023年德国气候变化与健康状况报告[13]2023德国卫生与保健专家委员会报告中提到的8个主题簇和行动建议，与WHO框架中关键领域密切相关，其中特别强调在领导与治理层面加强跨部门协调和政策整合，并通过基础设施改造、应急响应优化等措施，提高卫生体系的气候韧性。进一步指出财政资源、政策执行和公众意识仍然是未来需要重点关注的领域。
国家卫生适应计划第一阶段
（2021—2030）[14]		2021泰国公共卫生部结合框架，将重点放在政策与治理、传染病监测与预警系统等优先行动领域，以应对气候变化对健康的影响。且进一步强调了定期监测和评估的重要性，并设定了针对行动与监测评估的时间框架与阶段目标。
气候变化健康适应战略和
行动计划[15]		2023尼泊尔政府卫生和人口部计划参考WHO的6个质量标准，列出了5个主要目标下的详细行动计划，包括宣传和能力建设、气候敏感疾病的预防和控制、环境友好和气候适应的基础设施、将气候变化适应纳入政策以及多方合作与研究，并进一步针对每一项目标制定具体的监测与评估指标，给出关于每一项目标的活动计划的短期与长期估计成本。
2020—2024年国家气候变化公共卫生行动计划[16]2019柬埔寨卫生部参照WHO文件关于卫生体系气候韧性的10个组成部分制定相应的具体行动类别与相关衡量指标，制定行动计划矩阵，包括政府治理、跨部门协作、增强卫生人力等，并针对此给出进一步的评估监测方案。
国家健康与气候战略[17]2023澳大利亚卫生与老龄护理部在WHO框架的指导下，采取了系统性和科学化的策略，并结合本国自然背景、法规政策等实施计划，注重不同部门间的数据共享和职责分工，推动气候与健康系统的韧性建设。其强项在于治理与跨部门协作、科学研究驱动的政策制定等。
), ArticleFig(id=1320438125793493668, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320438118088557152, language=CN, label=表1, caption=

《建设具有气候韧性的卫生系统的操作框架》全球不同国家应用情况

, figureFileSmall=null, figureFileBig=null, tableContent=
文件名称时间发布部门应用情况
加拿大人群健康与气候变化：为行动增进我们的知识[8]2022加拿大卫生部借鉴WHO操作框架思路和组成部分，选取各部分可测量结果示例系统性评估了气候变化对不同人群的健康影响，并在领导力与治理、基础设施与技术等重点领域提出具体措施。
报告通过“先研究评估—再试点推广—最后全国实施”的方式，确保政策循序渐进地落地，提高执行的可行性和有效性。
孟加拉国卫生：国家适应计划[9]2018孟加拉人民共和国政府卫生和家庭福利部卫生服务总局
以操作框架的10个组成部分为基础，根据框架给出的战略目标对现状进行分析，提出水资源安全等主要障碍和适应方案，提出后续行动计划，指出将建设气候韧性策略与现有的卫生政策框架结合。同时列出对行动计划和预期可交付成果的监测和评价计划，包括指标、基线、核查手段、报告频率和责任机构。
在低收入和中等收入国家背景下建立和
加强适应气候变化的卫生系统[10]		2024挪威发展合作署框架指导在中低收入国家应从减少现有卫生系统脆弱性开始建立自身卫生体系的气候韧性。凭借框架提出的6个组成部分以理解和分类与卫生体系气候韧性有关的发现，进而参考此框架确定该研究领域需要进一步调查内容：可持续的融资、弱势群体、在现实环境中实施气候适应战略等。
加纳国家气候变化总体规划：
2015—2020年执行行动方案[11]		2015加纳国家气候变化委员会（NCCC）
加纳共和国环境、科学、技术和创新部		该行动计划参考框架，在框架所提出的卫生体系的组成部分领域针对气候韧性加强国家行为，特别针对气候变化影响评估和健康影响监测部分，并在每一个领域详细列出了行动目标、时间安排等。
气候综合医疗战略[12]2024奥地利联邦社会事务、卫生、护理和消费者保护部承诺参考建立气候韧性医疗系统的10个关键维度，用于指导奥地利医疗系统的结构调整与发展，制定具体措施和指标。
2023年德国气候变化与健康状况报告[13]2023德国卫生与保健专家委员会报告中提到的8个主题簇和行动建议，与WHO框架中关键领域密切相关，其中特别强调在领导与治理层面加强跨部门协调和政策整合，并通过基础设施改造、应急响应优化等措施，提高卫生体系的气候韧性。进一步指出财政资源、政策执行和公众意识仍然是未来需要重点关注的领域。
国家卫生适应计划第一阶段
（2021—2030）[14]		2021泰国公共卫生部结合框架，将重点放在政策与治理、传染病监测与预警系统等优先行动领域，以应对气候变化对健康的影响。且进一步强调了定期监测和评估的重要性，并设定了针对行动与监测评估的时间框架与阶段目标。
气候变化健康适应战略和
行动计划[15]		2023尼泊尔政府卫生和人口部计划参考WHO的6个质量标准，列出了5个主要目标下的详细行动计划，包括宣传和能力建设、气候敏感疾病的预防和控制、环境友好和气候适应的基础设施、将气候变化适应纳入政策以及多方合作与研究，并进一步针对每一项目标制定具体的监测与评估指标，给出关于每一项目标的活动计划的短期与长期估计成本。
2020—2024年国家气候变化公共卫生行动计划[16]2019柬埔寨卫生部参照WHO文件关于卫生体系气候韧性的10个组成部分制定相应的具体行动类别与相关衡量指标，制定行动计划矩阵，包括政府治理、跨部门协作、增强卫生人力等，并针对此给出进一步的评估监测方案。
国家健康与气候战略[17]2023澳大利亚卫生与老龄护理部在WHO框架的指导下，采取了系统性和科学化的策略，并结合本国自然背景、法规政策等实施计划，注重不同部门间的数据共享和职责分工，推动气候与健康系统的韧性建设。其强项在于治理与跨部门协作、科学研究驱动的政策制定等。
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WHO卫生体系气候韧性建设及评估工具的全球应用现状及对中国的启示
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郝洋 1 , 李娜 1 , 任明辉 1, 2, 3, 4, 5, *, *
中国公共卫生 | 综　述 2026,42(4): 479-487
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WHO卫生体系气候韧性建设及评估工具的全球应用现状及对中国的启示
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郝洋（2004—），本科在读，研究方向：全球卫生外交及卫生治理

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郝洋（2004—），本科在读，研究方向：全球卫生外交及卫生治理

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3北京大学首都卫生与健康发展研究院，北京 100191
4国家卫生健康委员会卫生体系改革与治理研究重点实验室（北京大学），北京 100191
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郝洋1, 李娜1, 任明辉1, 2, 3, 4, 5, *, *
作者信息
  • 1北京大学公共卫生学院全球卫生学系，北京 100191
  • 2北京大学中国卫生发展研究中心，北京 100191
  • 3北京大学首都卫生与健康发展研究院，北京 100191
  • 4国家卫生健康委员会卫生体系改革与治理研究重点实验室（北京大学），北京 100191
  • 5北京大学全球卫生研究院，北京 100191
通讯作者:
任明辉，E-mail：
作者简介:

郝洋（2004—），本科在读，研究方向：全球卫生外交及卫生治理

Global application of WHO′s building and measurement tools for climate-resilient health systems and its implications for China
Yang HAO1, Na LI1, Minghui REN1, 2, 3, 4, 5
Affiliations
  • 1Department of Global Health, School of Public Health, Peking University, Beijing 100191, China
  • 2China Center for Health Development Studies, Peking University, Beijing 100191, China
  • 3Beijing Institute for Health Development, Peking University, Beijing 100191, China
  • 4National Health Commission Key Laboratory of Health System Reform and Governance (Peking University), Beijing 100191, China
  • 5Institute for Global Health, Peking University, Beijing 100191, China
    • Corresponding Author:
    REN Minghui, E-mail:
出版时间: 2026-04-10 doi: 10.11847/zgggws1147334
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摘要
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目的

旨在系统性地总结和介绍WHO发布的卫生体系气候韧性建设与评估工具，深入分析其在全球的应用现状及各国应用策略，并为中国气候韧性卫生体系建设提供借鉴。

方法

采用系统性综述方法，于2024年12月1日至12月31日对Web of Science、WHO图书馆数据库、各国政府出版物、报告、卫生部门及相关主管部门官方网站、其他国际组织官方网站以及Google Scholar进行了2024年12月以前以英文或中文发表的政策或研究进行全面检索。经严格筛选，最终对纳入的10篇参考WHO相关文件的国家政府工作报告与行动方案进行深入分析。

结果

全球范围内，包括加拿大等高收入国家，以及孟加拉国等气候敏感型国家已参考应用。各国应用策略主要集中在政策嵌入、国际合作与联盟、渐进式执行以及本地化等方式。研究发现，中国在气候韧性卫生体系建设中，卫生人力领域建设有待进一步加强，且需合理借鉴各国的成功经验与策略，结合国情进行指标筛选、调整及更新。

结论

WHO的工具为全球卫生体系气候韧性建设提供了科学指导框架。各国应根据自身情况合理应用，以提升卫生体系的气候韧性。

气候韧性  /  卫生体系  /  全球现状  /  全球健康  /  评估工具
Objective

To summarize WHO′s building and measurement tools for climate-resilient health systems (CRHS), analyze their global application status and applications strategies in different countries, and inform China′s CRHS development.

Methods

The related literature including policies or studies published in English or Chinese before December 2024 was comprehensively searched against the Web of Science, WHO Library, government publications of different countries, reports, official websites of health departments and relevant authorities, other international organizations′ official websites, and Google Scholar. After rigorous screening, 10 WHO-aligned national government reports/action plans were included for in-depth analysis.

Results

Globally, high-income countries such as Canada and climate-sensitive nations such as Bangladesh have applied these tools. The strategies adopted by countries primarily focused on policy integration, international cooperation, phased implementation, and localization. China′s CRHS development still faces challenges, especially in the health talent domain. Accordingly, China needs strengthened health workforce development and context-specific adaptation of tools.

Conclusions

WHO tools provide vital guidance for building CRHS. Countries should adapt them contextually to enhance CRHS resilience.

climate resilience  /  health system  /  global application  /  global health  /  measurement tools
郝洋, 李娜, 任明辉. WHO卫生体系气候韧性建设及评估工具的全球应用现状及对中国的启示. 中国公共卫生, 2026 , 42 (4) : 479 -487 . DOI: 10.11847/zgggws1147334
Yang HAO, Na LI, Minghui REN. Global application of WHO′s building and measurement tools for climate-resilient health systems and its implications for China[J]. Chinese Journal of Public Health, 2026 , 42 (4) : 479 -487 . DOI: 10.11847/zgggws1147334
正文
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气候变化的健康威胁对未来卫生体系提供持续、有效的卫生服务提出了巨大挑战[1]，也对建设具有气候韧性的卫生体系提出了迫切需求。因此，世界卫生组织（World Health Organization, WHO）通过发布卫生体系气候韧性建设及评估相关文件，为各国应对当前气候变化带来的健康危机提供了路线图 [2–5]。国家疾病预防控制局联合相关部门于2024年9月发布了《国家气候变化健康适应行动方案（2024—2030年）》[6]，在建设本国卫生体系气候韧性和参与全球气候健康适应行动中展现了积极的姿态。本研究旨在通过系统综述的方法，总结WHO卫生体系气候韧性建设与评估工具的全球应用现状，总结和分析各国的应用策略，为中国建设具有气候韧性的卫生体系及评估工作提供参考与借鉴。
1　WHO卫生体系气候韧性建设及评估工具概况
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作为全球卫生治理领域的核心行为体，WHO在气候变化与健康领域通过以下途径发挥其作用，帮助各国应对气候变化的健康影响：（1）确保健康在气候变化议程中得到适当体现；（2）协助各方对气候变化与健康之间的联系和调查研究；（3）加强国家能力，提升卫生系统的气候韧性等。其中在提升卫生体系气候韧性部分，WHO先后于2015和2023年发布了《建设具有气候韧性的卫生系统的操作框架》和《建设具有气候韧性和低碳的卫生系统的操作框架》，并于2022年发布了《测量卫生体系的气候韧性》，为各国卫生体系气候韧性的建设与评估提供了核心指导。
《建设具有气候韧性和低碳的卫生系统的操作框架》（简称“操作框架”）首次提出“气候韧性”概念，并确定了卫生体系气候韧性建设中的6个关键模块：卫生服务、卫生工作力、医疗产品、卫生信息、财政、领导与治理，以及与这些模块紧密相连的10个关键组件[4]，如图1所示。《测量卫生体系的气候韧性》基于操作框架，重点关注卫生体系气候韧性的测量评估。文件将测量指标分为三大类：上游决定因素（暴露与脆弱性）、卫生系统功能的气候韧性、人口健康和卫生系统成果。每类指标下列举了具体示例，并提供了相应的数据来源。此外，文件还强调定期监测的重要性，指出监测能为提升气候韧性提供关键信息。为进一步补充操作框架，文件提出增强服务提供、完善健康信息系统等策略[2]，如图2所示。
2　资料与方法
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2.1　文献来源
本研究于2024年12月1日至12月31日对 Web of Science、WHO图书馆数据库、各国政府出版物、报告、卫生部门及相关主管部门官方网站、其他国际组织官方网站以及Google Scholar进行检索，纳入2024年12月以前以英文或中文发表的政策类或研究类文献。
2.2　检索策略
气候韧性（climate resilience）指一个系统（如自然生态系统、社会福祉系统）在气候变化影响下维持核心功能、吸收冲击并快速恢复的能力。气候适应性（climate adaptation）指通过主动调整系统，合理地最小化、避免气候变化负面影响或利用潜在机会的行为和策略。两者均旨在减少气候变化带来的风险，增强社会福祉和自然生态系统的可持续发展能力，共同构成应对气候变化的“防御—恢复”体系[7]。因此，本研究在检索各国相关文件时将“气候适应性”和“气候韧性”的文件一并纳入。使用的关键词包括：“climate resilience”“healthsystem”“operationalframework”“measuring”“health national adaptation plan”“climate adaptive”“healthcare system”“healthcare”，将以上关键词单独使用或通过布尔逻辑进行组合检索。
2.3　文献纳入和排除标准
纳入标准：（1）文献类型为各国国家政策或行动方案；（2）政策与研究领域为卫生体系的气候韧性；（3）参考文献包括 WHO《建设具有气候韧性的卫生系统的操作框架》 《建设具有气候韧性和低碳的卫生系统的操作框架》和《测量卫生体系的气候韧性》。排除标准：（1）重复发表的文献；（2）无法获取全文的文献；（3）未应用 WHO 相关工具制定的政策或行动方案。
2.4　文献筛选与数据提取流程
文献纳入和排除的筛选流程包括以下步骤：①去重：人工识别不同平台检索结果中的重复条目，剔除重复文献；②初筛：通过阅读标题和摘要，根据纳入和排除标准筛选文献并进行标记；③精筛：对初筛后的文献全文进行精读，根据纳入和排除标准确定最终纳入的研究文献；④确定标准化信息提取表，由本课题组全部成员通过讨论达成一致。信息提取过程使用 Excel软件完成。从每篇文章中摘录以下信息：文件名称、时间、发布部门、应用情况等。
2.5　质量控制
筛选和信息提取过程均由2名研究者独立平行进行。对于有异议的结果通过共同讨论统一意见。所有讨论未果的争议均提交至研究团队负责人进行仲裁。负责人依据其在该领域的专业学识作出最终判定，从而在机制上确保了整个工作的高度客观性和结果准确性。
3　结　果
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3.1　文献情况
本研究共检索到692篇相关文献，依据排除标准，最终纳入符合标准的10篇文献。筛选流程见图3。
3.2　《建设具有气候韧性的卫生系统的操作框架》应用现状
目前共有10个国家在制定行动方案时应用了 《建设具有气候韧性的卫生系统的操作框架》。主要国家分布于亚洲、欧洲及北美、非洲与大洋洲地区。具体见表1。
在建设与评估卫生体系气候韧性的过程中，当前各国重点关注领导力与治理、卫生人力等组件，并主要聚焦于以下关键领域（如图4所示）：治理与政策发展、跨部门协作、卫生人力资源能力建设、信息与意识提升、综合疾病监测与早期预警、基础设施与技术适应，以及健康的环境决定因素监测。相对而言，环境可持续性、健康环境决定因素监管、极端事件的风险管控以及健康部门的资金与融资等领域指标则相对较少地被纳入各国行动方案中。
3.3　《测量卫生体系的气候韧性》应用情况
目前只有加拿大参考应用了《测量卫生体系的气候韧性》框架，加拿大卫生部于2022年发布的《加拿大居民健康与气候变化行动报告》深入讨论了应对气候变化对健康影响的必要措施[8]。在第十章“适应与卫生系统韧性”中，报告采用《测量卫生体系的气候韧性》评估工具，主要体现在两方面：首先，该报告借鉴评估工具的框架，为卫生系统气候韧性建设提供系统性的操作指导，强调决策者应通过加强卫生工作力、财政支持、服务提供和健康信息系统等方面，提高系统的气候韧性；其次，报告结合加拿大具体国情选择性地应用《测量卫生体系的气候韧性》框架中的示例指标，聚焦气候信息监测、财政预算等短期气候变化风险的韧性评估。这种选择与加拿大在该领域仍处于起步阶段的现实情况相符。
4　讨　论
收起
4.1　各国应用策略分析
各国行动方案应用WHO工具的策略包括政策嵌入、国际合作与联盟、渐进式执行各项措施以及本地化。一方面，各国通过将WHO工具内容嵌入到本国的政策法规体系中深度实现对WHO工具的应用。如加拿大已将建设气候韧性策略纳入公共卫生政策划中，确保气候变化的影响在未来公共卫生规划中得以体现[8]。另一方面，各国通过与其他国家或组织建立合作关系或形成区域性联盟来共同推动WHO相关文件目标的实现，帮助本国应用和实施WHO工具。如加纳与多个国际组织合作，争取技术援助、资金支持及经验共享；还参与了多个区域性气候变化适应网络，利用国际合作提升本国的气候韧性[11]。各个国家选择分阶段实施应用WHO相关工具，这种逐步过渡有助于减少工具对国家原有系统的冲击，也使得工具应用过程更加灵活。以上各国均从气候变化短期健康风险起步，再逐步扩展至长期健康风险，通过时间层面的渐进式执行来确保工具应用的可行性和效果。除此之外，加拿大选择魁北克省为试点，再根据试点结果进行全国推广，在地域层面实施渐进式执行过程[8]。
此外，通过对各国在应用WHO工具中的指标筛选与使用情况进行分析，本文总结出其本地化策略，主要包括指标筛选与指标应用两个方面（如图5所示）。在指标的实际应用中，各国需根据自身情况进行筛选，以确保指标的有效性和针对性。首先，确保指标与本国自然、经济及社会背景高度匹配。例如，柬埔寨关注“气候韧性和低碳基础设施”，因此在选择指标时优先考虑相关领域[16]；挪威在低收入国家中重点选择“气候与健康监测系统”的建立，旨在减少现有卫生系统脆弱性[10]。其次，指标须与国家卫生战略及优先目标保持一致。例如，德国围绕可持续卫生体系目标，重点筛选“气候韧性的可持续基础设施与技术”相关指标。同时，指标须契合本国政策制度框架。如柬埔寨在性别敏感性政策框架下，选择了气候变化相关法规中的性别平等指标[16]。此外，数据源的可获取性、可靠性与持续性亦是关键考量，各国倾向于选择易于量化且数据稳定的指标。对于完全不适用的参考性指标，则直接删除。如尼泊尔属于高山内陆山地国家，不存在沿海地区，不受海平面上升影响，故“海平面上升健康风险”指标并不适用，尼泊尔政府在“暴露和脆弱性上游决定因素指标”选择过程中直接删除相关指标。
在指标应用阶段，应用策略主要包括直接采纳和调整后应用两种方式。对符合国家情况且可直接操作的指标采用直接采纳策略，如加拿大直接采纳“国家气候变化协调中心已建立”等基础指标[8]。对于不完全适用的指标或概括性指标则通过考虑适应性、可测量性和迭代更新实现本土化调整。考虑适应性因素即要求国家结合自然社会经济背景、政策目标、行动方案的时空尺度与文化特征延伸细化指标。例如，孟加拉国面临有限的水资源储存等气候影响，将“健康的环境决定因素管理”细化为“实施/扩大具有气候韧性的水安全计划”[9]；加拿大针对本地居民的多元文化差异，增加多元文化社区气候变化监测和预警能力相关指标，并提供“具有文化特色的气候变化和健康指标”[8]。考虑可测量性则要求国家针对数据统计不足的情况，采用替代性指标或调整量化方法。加拿大魁北克省依赖定性指标和专家意见，解决统计数据不足的问题[8]；加纳通过卫星数据补充气象站数据，提高准确性[11]。迭代更新则依托持续评估体系，根据卫生系统反馈与社会经济变化定期更新指标。以上本地化策略显著强化了WHO工具框架对国家卫生体系气候韧性建设的支持效能。
4.2　研究者与科研机构应用情况
学者与研究组织同样运用WHO工具在卫生体系气候韧性领域做出种种努力。在《将公共卫生纳入欧洲气候变化适应政策和规划》一文中，研究人员基于WHO框架构建分析工具，用于评估健康议题在不同国家气候韧性政策中的整合情况与不足之处[18]；《气候变化相关健康影响、风险、适应和复原力的监测和评估指标》中研究人员以WHO框架为基础提出了一套涵盖脆弱性、健康影响和韧性的指标体系，助力卫生系统追踪气候风险、评估建设气候韧性措施的效能并优化管理策略，进而通过实例分析提出国家行动改进方案[19]；除此之外，《在医疗保健设施中实施可持续实践以增强环境健康》中研究成员通过深度解析WHO框架的六大构建模块与十大行动领域，系统阐释其在本国卫生体系气候韧性建设中的价值，进而建议结合本地实际情况进行相应调整[20]。
4.3　对中国应用WHO工具建设具有气候韧性卫生体系的启示
根据上述国家应用现状的分析，各国在制定气候变化适应行动方案时普遍选用卫生人力领域指标。当前，医疗卫生人员在应对气候变化中的角色愈发重要，承担着关键职责，在疾病监测、推动健康促进行为、政府风险沟通以及行业领导者间的环保倡导等方面，展现出独特的优势[21]。中国于2024年9月发布的《国家气候变化健康适应行动方案（2024—2030年）》虽明确提出10项重点任务[6]，然而该方案中涉及加强卫生人力建设的具体建议和计划较少，可以考虑进一步增加卫生人力领域的相关指标，强化卫生人力资源的建设，提升该领域在气候变化应对中的作用与影响力。根据上述研究者及科研机构应用情况的分析，当前，国际学术界积极应用WHO框架分析各国气候健康适应政策的不足并提出优化建议。然而国内相关研究对WHO框架的应用仍显不足。值得关注的是，WHO框架涵盖的气候变化与健康核心议题与中国建设气候韧性的挑战高度重合；且WHO框架强调的应对路径与中国所推行的“健康中国2030”战略高度契合。因此，未来中国学者可以考虑加强WHO框架的学术应用，为改进和优化中国卫生体系气候韧性建设的行动方案提供更多高质量的科学依据和数据支持。这不仅有助于增强中国研究的国际可比性，也为制定更加科学、精准的政策提供坚实的理论支撑。
4.4　合理利用应用策略
结合以上国家应用策略分析结果，为系统应用WHO工具和指标，中国可考虑将气候韧性策略纳入《中华人民共和国基本医疗卫生与健康促进法》《“十四五”国民健康规划》等法规和核心政策，构建支持性政策环境；深化与WHO、UNFCCC等国际组织合作，利用国际交流平台学习经验、获取资源；鉴于国内地区差异，优先在经济发达及气候敏感区域（如东南沿海、北方干旱区）试点，再分阶段推广全国；而在指标本地化上，需基于国情适应性、战略一致性及数据可获取性进行指标筛选。指标筛选后，后续应结合地区实际情况细化指标并渐进迭代更新。

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2026年第42卷第4期
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doi: 10.11847/zgggws1147334
  • 接收时间：2025-03-07
  • 首发时间：2026-10-23
  • 出版时间：2026-04-10
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  • 收稿日期：2025-03-07
  • 修回日期：2025-09-03
  • 录用日期：2026-01-17
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    1北京大学公共卫生学院全球卫生学系，北京 100191
    2北京大学中国卫生发展研究中心，北京 100191
    3北京大学首都卫生与健康发展研究院，北京 100191
    4国家卫生健康委员会卫生体系改革与治理研究重点实验室（北京大学），北京 100191
    5北京大学全球卫生研究院，北京 100191

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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