LAUSR

The 2017 G7 Health Ministerial Meeting was on Nov 5–6, in Milan, Italy, and for the first time the effect of climate and environmental factors on health was addressed in the agenda of the meeting. As reported in the final Health Ministers communiquè after the meeting (signed by all seven countries), the delegation agreed to identify and promote some fundamental adaptation actions. In addition to the novelty of these subjects being in the agenda and in the final meeting documents, we believe the process that led to these outcomes is innovative and interesting. In 2016, the Italian G7 Presidency declared an intention to address the effects of climate change and environmental degradation on human and animal health and on food systems. The G7 Sherpas circulated a preliminary concept paper highlighting, among other items, The Lancet Commission on planetary health. After the first G7 health experts’ meeting, the Italian Presidency proposed a process to prepare for the Ministerial Meeting in November, 2017, consisting of two stages. Firstly, a comprehensive literature review that involves all the G7 health delegates and technical experts from leading international organisations that attend the meetings, and, secondly, a direct interaction with the scientific and academic world. To achieve a wide consensus on the priorities to be dicussed at the G7 Ministerial Meeting, more than 700 international experts identified by the G7 health experts were consulted via a Delphi questionnaire. This questionnaire was drafted by the technical team at the Italian Ministry of Health and a research team at the Ca’ Foscari University in Venice, Italy. This first questionnaire was based on information from international documents and articles. The quest­ ions were organised from a matrix with the following columns: exposure: the first element the experts were required to comment on, to highlight the potential health risk exposures due to climate change; health outcome: for each exposure, potential consequences for human and animal health were identified; expert statement: to ascertain the experts’ opinions on possible strategies to mitigate or adapt to the health outcome; and actions: to adapt health systems and health­ service delivery systems to the specific effects of climate change. Each of the matrix components cited official or background documents. The final matrix was agreed on via three face­to­face meetings between the G7 delegates (as well as experts from WHO, the Food and Agriculture Organization of the UN, the World Organisation for Animal Health, and the European Union) and mail consultations (via draft documents shared through a data­cloud service organised by the Italian Presidency). This first survery round yielded over 100 proposed adaptation actions (and a few mitigation actions considering the known co­benefits) with specific reference to health systems. Priority actions from this list were identified by scientists and academics who were also requested to define the role of G7 countries in the promotion of these priorities, and to indicate the timeframe for their potential effect. This prioritisation process was done via a web­based Delphi survey. On the basis of the answers collected from almost 200 experts in the first round and 130 in the second round of questionnaires, some clear and coherent messages emerged and were shown to the G7 delegation for policy appraisal and decision making (panel). As expected, the work done with the G7 delegates and international scientists through the Delphi procedure generated recommendations that are consistent with other experts’ opinions and works published in the field of planetary health. This work contributed to the first science­based draft of the G7 Health Ministerial Meeting communiquè, and to framing the discussion of policy makers within the boundaries of scientific evidence and consensus. Policy makers were provided with evidence for consideration, which was supported by several keynote presentations offered by world­leading experts and academics. We believe the innovative pre­ paratory work provided important opportunities to move forward on the international agenda, dealing with difficult and controversial issues. This was an interesting and prom­ ising exercise that showed how scientists and policy makers can find common terminology and semantics Panel: Main priorities suggested by international experts through the Delphi exercise