Perspective: A utilitarian approach to prioritization in climate and health research

Rapid global warming is triggering a wide range of changes to the climate, and these changes are compromising many aspects of human health and well-being. As a research community, we lack the time and resources to investigate the efficacy of every possible climate adaptation strategy for protecting health. Thus, we require a logical and ethical framework to inform prioritization of our climate-health research efforts. In this paper, we propose a utilitarian approach: our research focus should be on adaptation strategies that provide the greatest health and well-being for the greatest number. The disability-adjusted life year (DALY) - equal to one year of healthy life lost - allows us to compare across markedly different health outcomes and adaptation approaches. Given the importance of cost-effectiveness in resource-constrained settings, we could prioritize adaptation approaches based on "cost per DALY averted". Equally, we could base a priority ranking on "cost per quality-adjusted life year (QALY) gained". A DALY- or QALY-based ranking would not be the end product, but a quantifiable first step to frame prioritization discussions. Adopting a utilitarian approach is useful in extending this frame beyond considering only the health of current-day humans to also consider the health of future humans and the suffering of non-human animals. While the approach does have limits - to ensure an equitable prioritization we need to consider aspects of fairness and justice, moral concepts that utilitarianism has some difficulty incorporating - we argue that it provides a helpful starting point in prioritizing the climate-health adaptation research agenda.