A policy context and process analysis to implement the Paris Agreement on climate change in the health system of Iran

Ensuring public health is crucial in any policy debate on climate change. Paris Agreement on Climate Change is a global contract through which countries have committed themselves to a public health treaty. This study was conducted to identify the challenges that lie ahead for policymakers and provide an evidence-informed framework for policymaking to increase the resilience of Iran's health system to health consequences of climate change.

A qualitative study using semi-structured interviews was conducted with 25 experts. Purposeful and snowball sampling techniques were used for data gathering. Thematic content analysis was conducted with a deductive-inductive approach. Leichter's model, the stage's heuristic framework, and Kingdon's models were used for analyzing the context and process analysis respectively. MAXQDA 20 software was used.

A total of four main themes and twelve sub-themes were identified concerning various contextual factors, including political, economic, international, and cultural/social challenges. The primary obstacles to implementing adaptation measures were found to be political considerations, economic sanctions, and the low-risk perception held by both the public and policymakers. Additionally, fifteen themes and forty-eight sub-themes related to the process were identified across several areas: agenda setting, which includes the problem stream, policy stream, and politics stream; policy formulation, encompassing governmental and managerial aspects, research, evidence-informed policymaking, and the role of Non-Governmental Organizations; policy implementation, which covers early warning systems, education, inter-sectoral coordination, architecture and engineering, and integrated databases; and policy evaluation, focusing on inadequate evaluation methods.

The study identifies key challenges in implementing the Paris Agreement within Iran's health system, categorized into four main themes: political, economic, international, and cultural/social. Political issues stem from the politicization of climate change and national security concerns. Economically, reliance on oil and sanctions hinder progress, while high technology costs strain resources. Internationally, a lack of binding commitments and technological sanctions impede efforts. Culturally, low public awareness and inadequate inter-organizational collaboration limit engagement. The study emphasizes the need for cohesive policies, enhanced public education, and improved coordination among sectors to effectively address climate change impacts on health.