Paul Wilkinson

• London School of Hygiene and Tropical Medicine

Background Current evidence linking long-term exposure to fine particulate matter (PM2.5) exposure and mortality is primarily based on persons that live in the same residence, city and/or country throughout the study, with few residential moves or relocations. We propose a novel method to quantify the health impacts of PM2.5 for United States (US)...

Impacts of housing on health are well-recognised. Despite this, housing standards have been neglected and there are gaps in healthy housing policies, particularly in low and middle-income countries. Given the recent publication of the WHO Housing and health guidelines, and the need to implement these into policy at all scales, we carried out a focu...

There is a growing body of modelling evidence that demonstrates the potential for immediate and substantial benefits to adult health from greenhouse gas mitigation actions, but the effects on the health of younger age groups is largely unknown. We conducted a systematic review to identify the available published evidence of the modelled effects on...

Non-Technical SummaryTo meet the UK's greenhouse gas (GHG) emissions targets, the Climate Change Committee (CCC) recommended to reduce current meat and dairy intake by 20% by 2030. In this study, we modelled the impact of potential dietary changes on GHG emissions and water use with the selected scenarios based on the trend of food purchase and mea...

Background Current evidence linking fine particulate matter (PM2.5) exposure and mortality is primarily based on long-term exposure for persons that live in the same residence, city and/or country throughout the study, with few residential moves or relocations. We propose a novel method to quantify the health impacts of PM2.5 for United States (US)...

Most research on the air pollution-related health effects of decarbonization has focused on adults. We assess the potential health benefits that could be achieved in children and young people in a global sample of 16 cities through global decarbonization actions. We modelled annual average concentrations of fine particulate matter (PM2.5) and nitro...

Populations reliant on subsistence farming are particularly vulnerable to climatic effects on crop yields. However, empirical evidence on the role of the timing of exposure to crop yield deficits around early life development is limited. We examined child survival in relation to annual crop yield reductions at different stages around early life dev...

This research aimed to capture and synthesise the views of children, young people, parents and expectant parents (CYPP) about the cities where they live, with a specific focus on air pollution (AP), in order to support the generation of evidence-informed policy that reflects CYPP’s perspectives, ultimately contributing to the development of child-c...

Air purifiers (APs) and home sealing are interventions used to help protect U.S. diplomats against particle pollution in the home when working in polluted cities. We investigated the effect of these interventions on home indoor and personal PM2.5 exposure in Kathmandu, Nepal. Twenty-one participants underwent repeated 48 hour personal monitoring be...

Anthropogenic climate change will have a detrimental impact on global health, including the direct impact of higher ambient temperatures. Existing projections of heat-related health outcomes in a changing climate often consider increasing ambient temperatures alone. Population growth and structure has been identified as a key source of uncertainty...

Background: The UK is legally committed to reduce its greenhouse gas emissions to net zero by 2050. We aimed to understand the potential impact on population health of two pathways for achieving this target through the integrated effects of six actions in four sectors. Methods: In this multisectoral modelling study we assessed the impact on popu...

Anthropogenic climate change is projected to increase ambient temperatures, and the frequency, intensity and duration of extreme heat events worldwide. As a result, recent years have seen an increasing policy and research focus on the potential adverse effects of warm and hot weather on human thermal comfort, wellbeing, morbidity and mortality. Cer...

This chapter provides an overview of factors affecting heat-related morbidity and mortality in the Greater London Area. Evidence from past heatwave periods indicates that London’s Urban Heat Island effect contributes substantially to heat-related mortality rates. During a warm period in 2006, the proportion of heat deaths attributable to this effec...

The 2022 report of the Lancet Countdown is published as the world confronts profound and concurrent systemic shocks. Countries and health systems continue to contend with the health, social, and economic impacts of the COVID-19 pandemic, while Russia's invasion of Ukraine and a persistent fossil fuel overdependence has pushed the world into global...

Giorgos Petrou and colleagues argue for systematic large scale monitoring of indoor air to avoid unintended harms to health from home energy efficiency programmes

The presence of urban greenspace may lead to reduced personal exposure to air pollution via several mechanisms, for example, increased dispersion of airborne particulates; however, there is a lack of real-time evidence across different urban contexts. Study participants were 79 adolescents with asthma who lived in Delhi, India and were recruited to...

Background/objective Urban greenspace may have a beneficial or adverse effect on respiratory health. Our objective was to perform an exploratory systematic review to synthesise the evidence and identify the potential causal pathways relating urban greenspace and respiratory health. Methods We followed PRISMA guidelines on systematic reviews and se...

This paper describes a global research programme on the complex systemic connections between urban development and health. Through transdisciplinary methods the Complex Urban Systems for Sustainability and Health (CUSSH) project will develop critical evidence on how to achieve the far-reaching transformation of cities needed to address vital enviro...

People who relocate to a new environment may experience health effects from a change in ambient air pollution. We undertook a literature review of studies of such relocations and health effects and report the results as a narrative analysis. Fifteen articles of heterogeneous designs met the inclusion criteria. Four short-term (relocation duration l...

Background: Climate change and consequent increases in rainfall variability may have negative consequences for the food production of subsistence farmers in West Africa with adverse impacts on nutrition and health. We explored the pathway from rainfall through diet up to child undernutrition for rural Burkina Faso. Methods: The study used data of a...

In 2020, Covid-19-related mobility restrictions resulted in the most extensive human-made air-quality changes ever recorded. The changes in mobility are quantified in terms of outdoor air pollution (concentrations of PM2.5 and NO2) and the associated health impacts in four UK cities (Greater London, Cardiff, Edinburgh and Belfast). After applying a...

The warming climate causes adverse effects on thermal comfort and health, especially for vulnerable older adults. This study assesses the current and future risk of summertime overheating in London’s care homes and explores the potential of passive ventilation on reducing these risks. Analysis is based on temperature monitoring of two care settings...

With more than half the world’s population living in cities, understanding how the built environment impacts human health at different urban scales is crucial. To be able to shape cities for health, an understanding is needed of planetary health impacts, which encompass the human health impacts of human-caused disruptions on the Earth’s natural eco...

Contemporary challenges linked to public health and climate change demand more effective decision-making and urban planning practices, in particular by taking greater account of evidence. In order to do this, trust-building relationships between scientists and urban practitioners through collaborative research programmes is required. Based on a pol...

Summertime overheating in care settings has been identified as a key risk and research priority for the health and social care system. This paper examines the current and future risk of summertime overheating in two London-based care homes occupying modern and older buildings. Continuous monitoring of outdoor and indoor temperature in bedrooms, com...

Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the d...

Climate change means the UK will experience warmer winters and hotter summers in the future. Concurrent energy efficiency improvements to housing may modify indoor exposures to heat or cold, while population aging may increase susceptibility to temperature-related mortality. We estimate heat and cold mortality and energy consumption in London for t...

Background: A growing number of cities, including Greater London, have set ambitious targets, including detailed policies and implementation plans, to reach global goals on sustainability, health, and climate change. Here we present a tool for a rapid assessment of the magnitude of impact of specific policy initiatives to reach these targets. The d...

The Complex Urban Systems for Sustainability and Health (CUSSH) project is a global research programme on the complex systemic connections between urban development and health. Through transdisciplinary methods it will develop critical evidence on how to achieve the far-reaching transformation of cities needed to address vital environmental imperat...

Evidence about the impact of air pollution on cognitive development of children has been growing but remains inconclusive. To investigate the association of air pollution exposure and the cognitive development of children in the UK Millennium Cohort Study. Longitudinal study of a nationally representative sample of 13 058–14 614 singleton births, 2...

Cities produce more than 70% of global greenhouse gas emissions. Action by cities is therefore crucial for climate change mitigation as well as for safeguarding the health and wellbeing of their populations under climate change. Many city governments have made ambitious commitments to climate change mitigation and adaptation and implemented a range...

The COVID-19 pandemic has required health protection responses with far-reaching consequences for society, livelihoods, and the wider economy. Future enquiries will in time evaluate the success of responses at all scales. But emerging lessons highlight immediate implications for addressing the growing climate crisis through a recovery from COVID-19...

We explore methodological issues core to the cost-benefit evaluation of building adaptations designed to protect against heat risks to residents of care homes in England in the context of the uncertainties relating to the loss of life expectancy in heat death. We used building physics modelling to quantify the impact of external window shading on i...

Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the d...

Background Greenspace has been associated with health benefits in many contexts. An important pathway may be through outdoor physical activity. We use a novel approach to examine the link between greenspace microenvironments and outdoor physical activity levels in the HEALS study conducted in Edinburgh (UK), the Netherlands, and Athens and Thessalo...

Transformational change is urgently needed to address planetary health challenges in cities. Through an interdisciplinary overview of the literature, we consider how to frame and unpack city-level transformation towards synergistic benefits for urban health and environmental sustainability. By describing the characteristics of a ‘healthy sustainabl...

The 2019 Novel Coronavirus SARS-CoV 2 (COVID-19) pandemic has severely impacted global health, safety, economic development and diplomacy. The government of Nepal issued a lockdown order in the Kathmandu Valley for 80 days from 24 March to 11 June 2020. This paper reports associated changes in ambient PM2.5 measured at fixed-site monitors and chang...

The Lancet Countdown is an international collaboration established to provide an independent, global monitoring system dedicated to tracking the emerging health profile of the changing climate. The 2020 report presents 43 indicators across five sections: climate change impacts, exposures, and vulnerabilities; adaptation, planning, and resilience...

Background: A growing number of cities, including Greater London, have set ambitious targets, including detailed policies and implementation plans, to reach global goals on sustainability, health, and climate change. Here we present a tool for a rapid assessment of the magnitude of impact of specific policy initiatives to reach these targets. The d...

Background: Modeling suggests that climate change mitigation actions can have substantial human health benefits that accrue quickly and locally. Documenting the benefits can help drive more ambitious and health-protective climate change mitigation actions; however, documenting the adverse health effects can help to avoid them. Estimating the health...

Improved housing has the potential to advance health and contribute to the Sustainable Development Goals. Research examining housing, health and energy use in low-income countries is limited; understanding these connections is vital to inform interventions for healthy sustainable human settlements. This paper investigates the low-income setting of...

Housing quality is crucially linked to health and sustainability goals, yet there is limited research on informal housing and settlements where housing quality is poor, and the health risks are expected to be greatest. This paper describes the investigation of housing conditions in a low-income resettlement colony in Delhi. A novel transdisciplinar...

Introduction There is some evidence that exam results are worse when students are acutely exposed to air pollution. Studies investigating the association between air pollution and academic attainment have been constrained by small sample sizes. Methods Cross sectional educational attainment data (2009–2015) from students aged 15–16 years in Cardif...

This study is part of the “Air Polluion Impacts on Cardiopulmonary disease in Beijing: an integrated study of Exposure Science, Toxicologenomics & Environmental Epidemiology (APIC-ESTEE)” project under the UK-China joint research programme “Atmospheric Pollution and Human Health in a Chinese Megacity (APHH-China)”. The aim is to capture the spatio-...

James Milner and colleagues argue that carefully considered policies to lower carbon emissions can also improve health, and we should use these benefits to push for strong climate action © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to.

Cities face the interlinked challenges of transforming environmental quality, sustainability, population health and health equity. There is increasing interest in green infrastructure in connection with these challenges. In order to go beyond an understanding of the effects of green infrastructure and develop an understanding of how policymakers sh...

In May, 2019, a prominent group of scientists voted to designate a new geological epoch, the Anthropocene, that reflects the commencement of substantial human impact on the Earth’s systems. The scale of human impact is such that in many areas it threatens the functioning of the natural systems that sustain the health of human civilisation. Rockströ...

There were errors in this article as originally published.

The Lancet Countdown is an international, multidisciplinary collaboration, dedicated to monitoring the evolving health profile of climate change, and providing an inde pendent assessment of the delivery of commitments made by governments worldwide under the Paris Agreement. The 2019 report presents an annual update of 41 indicators across five key...

Background At least 145 urban health indicator (UHI) tools exist internationally. Previous studies have shown that public health researchers and practitioners produce them to inform built environment policy and decision making. Little research exists on their use and how it affects policy. This study used qualitative system dynamics to investigate...

Background/aim: The exposome includes urban greenspace, which may affect health via a complex set of pathways, including reducing exposure to particulate matter (PM) and noise. We assessed these pathways using indoor exposure monitoring data from the HEALS study in four European urban areas (Edinburgh, UK; Utrecht, Netherlands; Athens and Thessalo...

Global initiatives have raised awareness of the need for cross-departmental and cross-sectoral activities to support urban health, sustainability, and equity, with respective indicators routinely used as a way to catalyze and monitor action toward pre-defined goals. Despite the existence of at least 145 urban health indicator (UHI) tools globally,...

Background: Droughts affect around 52 million people globally each year, a figure that is likely to increase under climate change. Objectives: To assess the strength of empirical evidence on drought exposure as a risk factor for undernutrition in children < 5 years of age in low-and middle-income countries (LMICs). Methods: Systematic review of obs...

The Sustainable Development Goals (SDGs) recognise the critical need to improve population health and environmental sustainability. This paper describes the development of a microsimulation model, MicroEnv, aimed at quantifying the impact of environmental exposures on health as an aid to selecting policies likely to have greatest benefit. Its metho...

In subsistence farming populations of sub-Saharan Africa reliant on rainfed agriculture, years of low crop yields result in poorer child nutrition and survival. Estimates of such impacts are critical for their reduction and prevention. We developed a model to quantify such health impacts, and the degree to which they are attributable to weather var...

To tackle global challenges, research collaborations need to integrate multiple disciplinary perspectives and connect with local practices to find solutions that are sustainable and impactful. This paper discusses how participatory action research (PAR) is used as a framework for transdisciplinary collaboration to integrate different disciplines an...

Societal impact is an increasingly important imperative of academic funding. However, there is little research to date documenting how impact is accomplished in practice. Drawing on insights from Actor-Network Theory, we explore the research-policy interface within an interdisciplinary research project on the relationships between air pollution and...

Globally, urban populations are growing rapidly, and in most cases their demands for resources are beyond current limits of sustainability. Cities are therefore critical for achieving national and international sustainability objectives, such as greenhouse gas reduction. Improving sustainability may also provide opportunities for urban population h...

Background England, and the UK more generally, has a large burden of winter- and cold-related mortality/morbidity in comparison with nearby countries in continental Europe. Improving the energy efficiency of the housing stock may help to reduce this, as well as being important for climate change and energy security objectives. Objectives To evalua...

Introduction The Secure Anonymised Information Linkage (SAIL) databank facilitated linkage of routinely collected health and education data, high spatial resolution pollution modelling and daily pollen measurements for 18,241 pupils in 7 cross-sectional cohorts across Cardiff city, UK, to investigate effects of air quality and respiratory health co...

Introduction: There is a lack of evidence on the adverse effects of air pollution on cognition for people with air quality-related health conditions. We propose that educational attainment, as a proxy for cognition, may increase with improved air quality. This study will explore whether asthma and seasonal allergic rhinitis, when exacerbated by ac...

Mortality rates rise during hot weather in England, and projected future increases in heatwave frequency and intensity require the development of heat protection measures such as the adaptation of housing to reduce indoor overheating. We apply a combined building physics and health model to dwellings in the West Midlands, UK, using an English Housi...

To date, greenhouse gas (GHG) emissions, mitigation strategies and the accompanying health co-benefits in different economic sectors have not been fully investigated. The purpose of this paper is to review comprehensively the evidence on GHG mitigation measures and the related health co-benefits, identify knowledge gaps, and provide recommendations...

Background Floods are the most common type of natural disaster globally. Climate change and the pressures of development to accommodate increasing population sizes could increase the number of people at risk of flooding. Although the immediate risk of death and injury from flooding is small in high-income countries, reports suggest that flooding ha...

The Lancet Countdown tracks progress on health and climate change and provides an independent assessment of the health effects of climate change, the implementation of the Paris Agreement, and the health implications of these actions. It follows on from the work of the 2015 Lancet Commission on Health and Climate Change, which concluded that anthro...

Background and objectives: Public health co-benefits from curbing climate change can make greenhouse gas (GHG) mitigation strategies more attractive and increase their implementation. The purpose of this systematic review is to summarize the evidence of these health co-benefits to improve our understanding of the mitigation measures involved, pote...

The so far largely unabated emissions of greenhouse gases (GHGs) are expected to increase global temperatures substantially over this century. We quantify the patterns of increases for 246 globally-representative cities in the Sustainable Healthy Urban Environments (SHUE) database. We used an ensemble of 18 global climate models (GCMs) run under a...