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The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate
Abstract
The Lancet Countdown is an international, multidisciplinary
collaboration, dedicated to monitoring the
evolving health profile of climate change, and providing
an independent
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 domains: climate change
impacts, exposures, and vulnerability; adaptation, planning,
and resilience for health; mitigation actions and
health co-benefits; economics and finance; and public
and political engagement. The report represents the
findings and consensus of 35 leading academic institutions
and UN agencies from every continent. Each
year, the methods and data that underpin the Lancet
Countdown’s indicators are further developed and
improved, with updates described at each stage of this
report. The collaboration draws on the world-class
expertise of climate scientists; ecologists; mathematicians;
engineers; energy, food, and transport experts;
economists; social and political scientists; public health
professionals; and doctors, to generate the quality and
diversity of data required.
The science of climate change describes a range of
possible futures, which are largely dependent on the
degree of action or inaction in the face of a warming
world. The policies implemented will have far-reaching
effects in determining these eventualities, with the
indicators tracked here monitoring both the present-day
effects of climate change, as well as the worldwide
response. Understanding these decisions as a choice
between one of two pathways—one that continues with
the business as usual response and one that redirects to a
future that remains ‘‘well below 2°C’’—helps to bring the
importance of recognising the effects of climate change
and the necessary response to the forefront.
Evidence provided by the Intergovernmental Panel on
Climate Change, the International Energy Agency, and
the US National Aeronautics and Space Administration
clarifies the degree and magnitude of climate change
experienced today and contextualises these two pathways.
... Currently, climate change is the greatest hazard to humankind, threatening our natural sources of life and the survival of our civilisation [1][2][3]. Although countries have committed to limiting global warming to well below 2 • C (as part of the Paris Agreement), global greenhouse gas emissions continue to increase [1]. ...
... The underlying research questions related to (1) how the public perceives the overall relevance of climate change; (2) how risks and health consequences associated with climate change are perceived, and (3) what individual and collective options for action against climate change exist. The main results regarding these research questions were that the majority of a public population (1) acknowledged the existence of climate change and its implications for human health and were concerned about the associated risks of climate change, (2) perceived that other population groups would be more strongly impacted by climate change than the German population and themselves, and (3) claimed to contribute to climate protection, while noting potential improvements in the climate change mitigating activities of cities and councils. ...
... In the scientific community, there is a consensus that climate change is human-induced and associated with wide-ranging environmental changes that may negatively impact human health. Accordingly, climate change is considered the greatest existential challenge faced by humanity [1,2,8,20]. Despite this, research from 2018 [16] found that the public perception of climate change in Germany was characterised by psychological distance, with most participants downplaying its associated health risks. ...
Climate change is inseparably linked to human health. Although there is growing awareness of the threats to human health caused by climate change, it remains unclear how the German population perceives the relevance of climate change and its health consequences. Between May and September 2022, German residents were invited to participate in a cross-sectional online survey that explored three content areas: (1) the relevance of climate change, (2) health risks in connection with climate change and (3) collective and individual options for action against climate change. A total of 697 full data sets were collected for analysis (72% female, 51% ≥55 years old). The majority of participants agreed that human-induced climate change exists (85%), and that it has an impact on human health (83%). They also perceived the global population to be more strongly impacted by climate change than themselves (89% versus 68%). Most participants (76%) claimed to personally contribute to climate protection and 23% felt that their city or council contributed to climate protection. Although the majority of participants saw climate change as a threat to human health, they perceived other population groups to be most strongly affected. Cognitive dissonance might explain this lack of individual concern and one approach to addressing such distorted perceptions might be the dissemination of appropriate risk communication with health professionals involved in the communication.
... Climate change negatively impacts health determinants (e.g., agriculture and access to water) at the global level. These effects affect populations who might be barely accountable for the problem, thus exacerbating issues between countries associated with social and economic inequality [4]. The global food system has failed to substantially improve the second sustainability goal on hunger, mainly due to poor management and distribution, with the frailty of the system highlighted by the COVID-19 pandemic. ...
... Climate change may influence food production and nutrition security due to its impact on the agro-ecosystem [37]. Effects on quantity, quality, access to, and affordability of foods from agricultural, fishery, and livestock sectors exacerbate nutrient deficiencies, chronic undernutrition, and vulnerability among the most food-insecure population groups [4,7,38]. Furthermore, current changes in climate are influenced by food systems and modern consumption patterns. ...
... Climate change may worsen the nutrient value of foods. Trends in climate suitability for disease transmission are also particularly concerning, with children among the most susceptible [4,39]. A link between increasing temperature and obesity has also been also suggested due to both a reduction in physical activity and the effects on fruit and vegetable production, leading to increased prices and shifts towards cheaper processed food and beverages [7]. ...
The pandemics of obesity, undernutrition, and climate change represent severe threats to child health. They co-occur; interact with each other to produce sequelae at biological, psychological, or social levels; and share common underlying drivers. In this paper, we review the key issues concerning child diet and nutritional status, focusing on the interactions with climate and food systems. Inadequate infant and young child feeding practices, food insecurity, poverty, and limited access to health services are the leading causes of malnutrition across generations. Food system industrialization and globalization lead to a double burden of malnutrition, whereby undernutrition (i.e., stunting, wasting, and deficiencies in micronutrients) coexists with overweight and obesity, as well as to harmful effects on climate. Climate change and the COVID-19 pandemic are worsening child malnutrition, impacting the main underlying causes (i.e., household food security, dietary diversity, nutrient quality, and access to maternal and child health), as well as the social, economic, and political factors determining food security and nutrition (livelihoods, income, infrastructure resources, and political context). Existing interventions have the potential to be further scaled-up to concurrently address undernutrition, overnutrition, and climate change by cross-cutting education, agriculture, food systems, and social safety nets. Several stakeholders must work co-operatively to improve global sustainable nutrition.
... The most immediate and direct impact of a warming climate on people's health results from rising temperatures, and the increased frequency, intensity, and duration of extremes of heat (Watts et al., 2019). The IPCC (2022) has warned that due to climate change, the percentage of the global population exposed to heat stress is projected to increase from around one in three today, to 48%-76% by the end of the century. ...
... In 2018, there were an estimated 220 million heatwave exposures affecting older populations, while modeling suggests there are 490,000 heat-related deaths each year (Zhao et al., 2021). Other consequences of heat exposure include heat stress, heat stroke, dehydration, accelerated deaths from chronic illnesses (such as cardiovascular disease), increased risk of accidents, impacts to mental health and increased risks of interpersonal and collective violence (Watts et al., 2019;WHO, 2018). The ways in which heat is problematized differ according to places, people, and practices it affects and is influenced by and hence drives the way initiatives are deployed to alleviate the impacts of this risk (Oppermann et al., 2017). ...
... The ways in which heat is problematized differ according to places, people, and practices it affects and is influenced by and hence drives the way initiatives are deployed to alleviate the impacts of this risk (Oppermann et al., 2017). Certain populations are known to be at greater vulnerability to extreme heat events, including older people, children, outdoor workers, certain marginalized communities, as well as people who are socially isolated, economically disadvantaged or live with chronic illnesses (Watts et al., 2019;WHO, 2018). ...
Heat risks, such as those associated with heatwaves, are increasing in frequency, severity, and duration due to climate change. The ways in which people around the globe perceive and respond to heat risks are now of great importance to reduce a range of negative health outcomes. A growing body of literature aims to assess the factors that influence people's behaviors in relation to heat risks. This research can inform better interventions, such as improved communications approaches, that attempt to facilitate adaptive behavioral responses to such risks. This review focuses on how insights from behavioral and attitudinal studies about heat risk responses can inform communication approaches. These insights are organized into three key themes: (1) Behaviors—What types of actions can be taken by people, and what evidence is there for adaptive behavior? (2) Antecedents—Which individual and contextual factors can influence people's behaviors? (3) Communications—How can existing insights be better integrated into interventions? Aspects of communication, including the role of message characteristics, messenger, and imagery, are discussed, with examples of messages and narratives that target influential antecedents of adaptive responses to heat risks. The paper makes three important contributions. First, it organizes literature on the antecedents and behavioral responses to heat risk; second, it provides a typology of the range of heat risk behaviors; and, third, it discusses how antecedents can be integrated into communication interventions. The review concludes with a proposed agenda for research, highlighting the need for substantial testing and evaluation of heat risk communication, applying insights from the literature.
This article is categorized under: Perceptions, Behavior, and Communication of Climate Change > Communication
Perceptions, Behavior, and Communication of Climate Change > Behavior Change and Responses
... The health care industry contributes between 4 and 5% of global greenhouse gas emissions. 1 Extreme temperatures and other effects of climate change cause excess morbidity and mortality. 2 In Canada alone, data suggest that negative environmental impacts account for an annual loss of over 23,000 disability-adjusted life years. ...
... Promouvoir un changement de pratique vers des soins de santé durables sur le plan environnemental -plus que des apparences Promouvoir un changement de pratique vers des soins de santé durables sur le plan environnemental: plus que des apparences L'industrie des soins de santé est responsable d'entre 4 et 5 % des émissions mondiales de gaz à effet de serre. 1 Les températures extrêmes et les autres effets du changement climatique entraînent une morbidité et une mortalité excessives. 2 Au Canada seulement, les données suggèrent que les impacts environnementaux négatifs représentent une perte annuelle de plus de 23 000 années de vie ajustées à l'incapacité. 3 En 2021, le Groupe d'experts intergouvernemental sur l'évolution du climat a émis un avertissement urgent, « Code rouge pour l'humanité », notant que nous nous rapprochons de plus en plus du seuil d'augmentation de la température mondiale de 1,5°C fixé dans l'Accord de Paris. ...
... Not only will natural disasters accentuate current inequalities in access to healthcare but also an exacerbation of poverty and violent conflict will end up affecting ''people of all ages and all nationalities.'' 1 Since 2014, the Canadian Anesthesiology Society's International Education Fund (CASIEF) has organized over 250 international trips with its partner organizations. Of note, an equal partner in the Guyana and Rwanda programs is the American Society of Anesthesiologists Global Humanitarian Outreach committee (ASAGHO), also represented in the authorship of this paper (A. ...
... 4 Indeed, healthcare professionals, in global health and beyond, are developing an environmental conscience as we learn from evidence-based data including the sobering Lancet report. 1 The anticipated consequences of climate change have resulted in leading global health organizations such as Médecins Sans Frontières to quote ''reducing the environmental impact'' of their activities as a top mandate priority. 5 The Canadian Anesthesiology Society's International Education Fund also values prioritizing environmentally conscientious decisions in global outreach efforts. ...
PurposeInternational partnerships have an important role in capacity building in global health, but frequently involve travel and its associated carbon footprint. The environmental impact of global health partnerships has not previously been quantified.Methods
We conducted a retrospective internal audit of the environmental impact of air travel for the international education programs of the Canadian Anesthesiology Society’s International Education Fund (CASIEF). We compiled a comprehensive list of volunteer travel routes and used the International Civil Aviation Organization Carbon Emissions Calculator, which considers travel distance, passenger numbers, and average operational data for optimized estimates. Comparisons were made with average Canadian household emissions and disability adjusted life years (DALYs) lost from climate change consequences.ResultsThe total carbon dioxide emitted (CO2-e) for the Rwanda, Ethiopia, and Guyana CASIEF partnerships were 268.2, 60.7, and 52.0 tons, respectively. The DALYs cost of these programs combined is estimated to be as high as 1.1 years of life lost due to the effects of CO2-e. The mean daily carbon cost of the average Rwanda partnership was equivalent to daily emissions of 2.2 Canadians (or 383 Rwandans), for the Guyana partnership was equivalent to 1.6 Canadians (or 7.6 Guyanese people), and for the Ethiopia partnership was equivalent to 2.4 Canadians (or 252 Ethiopian people).Conclusions
Air travel from these CASIEF partnerships resulted in 380.9 tons CO2-e but also enabled 5,601 volunteer days-in-country since 2014. The estimated environmental cost needs to be balanced against the impact of the programs. Regardless, carbon-reduction remains a priority, whether by discouraging premium class travel, organizing longer trips to reduce daily emissions, prioritizing remote support and virtual education, or developing partnerships closer to home.
... Bereits heute schadet der Klimawandel der Gesundheit vieler Menschen. Sein negativer Einfluss wird in den kommenden Jahrzehnten zunehmen und die Gesundheitssysteme erheblich herausfordern [3]. Dabei ist das Gesundheitswesen selbst global und in Deutschland für etwa 5 % der gesamten Treibhausgasemissionen verantwortlich [3,4]. ...
... Sein negativer Einfluss wird in den kommenden Jahrzehnten zunehmen und die Gesundheitssysteme erheblich herausfordern [3]. Dabei ist das Gesundheitswesen selbst global und in Deutschland für etwa 5 % der gesamten Treibhausgasemissionen verantwortlich [3,4]. Alle Akteure im Gesundheitswesen sind damit sowohl Verursacher als auch Verantwortliche im Management der Konsequenzen des Klimawandels. ...
... Periods of extreme heat or heatwaves continue to become an unwelcome experience for many and pose several damaging impacts on livelihoods and the environment. Vulnerability to extremes of heat has steadily risen since 1990 in all regions, with over 220 million people exposed to heatwave events in 2018 (Watts et al., 2019). Studies have indicated that the young and the elderly are particularly susceptible and affected by heatwaves, and yet global crop production has been significantly reduced with substantial effects expected in the future (Arbuthnott & Hajat, 2017;Deryng et al., 2014;Watts et al., 2019;Zampieri et al., 2017). ...
... Vulnerability to extremes of heat has steadily risen since 1990 in all regions, with over 220 million people exposed to heatwave events in 2018 (Watts et al., 2019). Studies have indicated that the young and the elderly are particularly susceptible and affected by heatwaves, and yet global crop production has been significantly reduced with substantial effects expected in the future (Arbuthnott & Hajat, 2017;Deryng et al., 2014;Watts et al., 2019;Zampieri et al., 2017). Between 1980 and 2019, the Emergency Events Database (EM-DAT) has listed occurrences of 83 heatwaves in Europe, resulting in over 140,000 deaths and more than US$12 billion damages for only the 2003 heatwave event (Harrington & Otto, 2020). ...
Uganda’s temperatures have risen by 0.78oC in the last seven decades and are projected to increase by about 2℃ to 5℃ in the next 50-80 years. This compounded with changes in climate and the urban heat island effect is becoming a significant challenge, thereby increasing urban heat risk. This study set out to analyse heat risk perception and communication strategies for adaptation amongst low-income communities in Kampala city and deployed literature review, surveys, focus group discussions and key informant interviews as data collection methods. The findings revealed that informal settlements and business corridors are hotter than the surroundings with conditions like dense housing, absence of vegetation cover, ecosystems degradation, air pollution and prevalence of critical transport hubs increasing their susceptibility to heat risk. Heat exposure was frequently associated with age, marital status, main income source and monthly income of individuals living or working in the informal sector. Extreme temperature was frequently perceived to affect health through; headache, excessive sweating, prolonged thirst, tiredness, dizziness, dehydration and increased health expenditures. Heatwaves were reported to reduce movement of people and water availability as surface water sources dry up. Extreme temperatures were indicated to reduce sale of warm/hot drinks and food, food spoilage and wastage which reduces the viability of business enterprises dealing in food products, and labour productivity. Further, heatwaves were found to increase energy costs and air pollution. Heat risk effects are more significant in children, pregnant women, the elderly, chronically ill, the homeless, albinos and people working in the open. Hardly any city-wide and community level interventions exist to increase awareness and ability to address heat risk. However, there have been some efforts geared towards reducing the heatwaves effect such as; greening the city’s road infrastructure, creation of a non-motorised transport corridor, tree planting and protection of green infrastructure. urban heat risk is a problem in Kampala city, it affects informal sector livelihoods and yet it is not well documented and appreciated for better awareness, preparedness and adaptation planning. It is recommended that multi-stakeholder research and actions are required to generate the requisite evidence that informs urban development policy, planning and practice across various scales.
... CVDs are mainly thought of as multifactorial and lifestyle-linked by all professionals, although several doctors appeared aware of how temperature affects the cardiovascular system. This was perhaps due to the tendency to disconnect temperature from climate change making it difficult for participants to connect it to the broader climate change manifestations, despite the growing number of studies conducted on the topic [45,48,49]. All participants also described being disconnected from the current climate-health research, and not having awareness of research and new developments by other national and international institutes. ...
Climate change has far-reaching impacts on human health, with low- and middle-income countries, including India, being particularly vulnerable. While there have been several advances in the policy space with the development of adaptation plans, little remains known about how stakeholders who are central to the strengthening and implementation of these plans perceive this topic. We conducted a qualitative study employing key interviews with 16 medical doctors, researchers, environmentalists and government officials working on the climate change agenda from Puducherry, India. The findings were analysed using the framework method, with data-driven thematic analysis. We elucidated that despite elaborating the direct and indirect impacts of climate change on health, there remains a perceived gap in education and knowledge about the topic among participants. Knowledge of the public health burden and vulnerabilities influenced the perceived health risks from climate change, with some level of scepticism on the impacts on non-communicable diseases, such as cardiovascular diseases. There was also a felt need for multi-level awareness and intervention programmes targeting all societal levels along with stakeholder recommendations to fill these gaps. The findings of this study should be taken into consideration for strengthening the region’s climate change and health adaptation policy. In light of limited research on this topic, our study provides an improved understanding of how key stakeholders perceive the impacts of climate change on health in India.
... With the increasing frequency of adverse climate events, there is an increase in research outlining the substantial effects of climate on human health (Watts et al., 2019, Pörtner et al., 2022. There is also a growing body of evidence that suggests that the health services are overburdened with the increasing number of patients presenting with climate-related health conditions and emergencies (Crowley et al., 2016, Sen et al., 2017, Romanello et al., 2022. ...
... The residential sentiment reflects interactions such as people's perceptions of the city environment and events (DAVIDSON & BONDI, 2004). Current research has made positive progress in studying the relationships between residential sentiment, urban landscape, and climate change (Watts et al., 2019), mainly using questionnaires and wearable sensor methods (Benita et al., 2019;Krefis et al., 2018). Studies from multiple countries and regions have shown that the quality and quantity of urban green spaces positively impact public sentiment (Maas et al., 2006;Takano et al., 2002;Zhang et al., 2020). ...
... 22,23 Although the research suggests that social prescribing may reduce healthcare usage, more research is needed to establish if it reduces prescribing of medication. 24 Nonpharmaceutical practices that decrease emissions have the potential to lead to better patient care, cost saving, and staff satisfaction. 25,26 This can be achieved by multiple pathways, including preventing illness and avoiding healthcare utilization, better diet, less pollution, more active travel, reduction in harmful or low value prescribing, upskilling, and involving staff in quality improvement. ...
Healthcare emissions and prescribing in primary care
The World Health Organisation (WHO) describes climate change as the single biggest health threat facing humanity. Already, preventable environmental related deaths are 13 million a year worldwide,¹ a fifth of global mortality. The number of these deaths is estimated to grow, with the effects of climate change increasingly contributing; every 4,000 tonnes of carbon emitted globally leads to 1 excess preventable death, and each tonne emitted inflicts a social cost of $258.² Carbon emissions and climate change contribute to increased burdens of heat-related illnesses, infectious diseases, mental illness, chronic diseases, food and water scarcity, and decreased air quality. The emissions related issue of air pollution alone causes 7 million deaths worldwide.³ Despite health services being charged with protecting the wellbeing of citizens, they are major carbon emitters.
If the healthcare industry was a country, it would be the fifth largest carbon emitter on the planet.⁴ Internationally, health services account for 4.4% of the world’s carbon emissions⁵—2 gigatonnes of carbon dioxide each year.⁶ As of yet, only the United Kingdom, Spain, Kenya, Jordan, and Nigeria having committed to net-zero health systems.
... 4-6 It has been estimated that Canada's healthcare system generates 33 million tons of GHG emissions annually, making it responsible for 4.6% of the national total and the third leading GHG industry emitter. 7,8 This issue seems consistent internationally, as healthcare in the United States contributes 8.5% of the nation's GHG emissions. 9 Globally, healthcare is estimated to contribute 4.4% of total emissions, which means that if healthcare was an country, it would be the 5th largest global emitter. ...
Objective. Healthcare systems, specifically operating rooms, significantly contribute to greenhouse gas emissions. Addressing operating room environmental sustainability requires understanding current practices, opinions, and barriers. This is the first study assessing the attitudes and perceptions of otolaryngologists on environmental sustainability. Study Design. Cross-sectional virtual survey. Setting. Email survey to active members of the Canadian Society of Otolaryngology-Head and Neck Surgery. Methods. A 23-question survey was developed in REDCap. The questions focused on four themes: (1) demographics, (2) attitudes and beliefs, (3) institutional practices, and (4) education. A combination of multiple choice, Likert-scale, and open-ended questions were employed. Results. Response rate was 11% (n = 80/699). Most respondents strongly believed in climate change (86%). Only 20% strongly agree that operating rooms contribute to the climate crisis. Most agree environmental sustainability is very important at home (62%) and in their community (64%), only 46% said it was very important in the operating room. Barriers to environmental sustainability were incentives (68%), hospital supports (60%), information/knowledge (59%), cost (58%), and time (50%). Of those involved in residency programs, 89% (n = 49/55) reported there was no education on environmental sustainability or they were unsure if there was. Conclusion. Canadian otolaryngologists strongly believe in climate change, but there is more ambivalence regarding operating rooms as a significant contributor. There is a need for further education and a systemic reduction of barriers to facilitate eco-action in otolaryngology operating rooms.
... 3 One of the main difficulties underlying the health-climate-inequality nexus is the fact that the climate crisis remains the largest threat to public health in the 21st century. 4 The challenges posed by climate change for human health and healthcare systems are therefore numerous. Socio-economic vulnerabilities compound direct and indirect health risks emerging due to climate change, and in turn increase health inequity, including due to injury and mortality from extreme weather events, heat-related illnesses, respiratory illnesses, water-borne diseases or water-related health impacts, zoonoses, vector-borne diseases, malnutrition and food-borne diseases, and negative consequences for mental and psychosocial health. ...
The climate crisis constitutes the largest threat to public health in the 21st century, from which several climate-sensitive direct or indirect health risks emerge. It is noteworthy that the health impact of the climate crisis disproportionately falls on groups with lower socio-economic status, which generally have lower adaptation capacities. There is, however, a huge potential for health policy to contribute to climate change mitigation and for climate policy to reduce disease burden. Policymakers are becoming increasingly aware of the link between health and climate. This nexus is further correlated with inequality, the latter here understood as the unequal distribution of social, political, economic and environmental resources, and health inequity. At the EU level, commitments to reducing net GHG emissions by at least 55% compared to 1990, by the year 2030 and to reach net-zero emissions by 2050 have been formulated within the framework of the European Green Deal and the Fit-for-55 package. Yet, neither does the European Green Deal consider health explicitly, nor does the EU4Health Programme include climate change mitigation or adaptation among its key objectives. Against this background, this policy brief explores risks associated with acting in silos and thus neglecting the interactions between climate, health and inequality, and looks for potential synergies when establishing a sound cli- mate-health-inequality nexus. It further addresses the question as to where the barriers lie for successfully exploiting these synergies between health and climate policy fields. This research showcases potential pitfalls when climate policy does not con- sider health, and when health policy does not take into account interactions with climate change. It also demonstrates that the interdependencies of climate and health create various opportunities. This policy brief is concluded with recommendations for policymakers with a view to addressing health, climate and ine- quality in an integrated manner. These recommendations seek to strengthen the climate-health-equality-nexus in the EU.
... At the EU level, in particular in the tourist sector, the potential of the human-centered approach is recognized first of all to increase competitiveness and results in advantages for society as a whole in terms of economic growth and job creation [25] as well as decreased consumption of ecological resources [19]. The interpretation of the human-centered approach in a wider perspective is coherent with a more comprehensive understanding of the circular economy model [26], which embraces not only the aspects related to the industrial symbiosis but also the other issues, such as human health [27] and the rebalancing of the connections between people and ecosystems [28][29][30][31]. ...
As underlined by OECD and United Nations, as cities are growing in size, they will face challenges in becoming climate neutral, reducing their environmental footprint, and meeting the growing needs of their populations. In cities, the main challenges of sustainable development are concentrated. So, there is a need to identify a new development model in order to make cities more sustainable. This necessity concerns all sectors, including the tourism one, which represents the third largest socio-economic activity in Europe. The tourism sector puts pressure on the city, increasing waste generation, noise and air pollution, and congestion in infrastructure and public areas. In addition, it is organized according to the linear economy model. This linearity is particularly visible in cities as people here tend to choose comfort over sustainability. In this framework, new approaches, strategies, and tools are required in order to make the tourism sector more sustainable, thus reducing its negative impacts on cities. In this perspective, the Human Circular Tourism (HCT) model is proposed. The aim of this study is to provide an operational framework consisting of recommendations, actions, and indicators to effectively operationalize the Human Circular Tourism model and to support public authorities (and other tourism stakeholders) in the identification of efficient policies in the tourism sector.
... "Ensuring that the health of a child born today is not defined by a changing climate". (Aus Watts et al. [24]) ...
Background
Heat days are becoming more frequent and intense in Germany. Children are also affected by heat. The aim of this study was to show to what extent children in Germany are already affected by heat stress.MethodsA literature search was carried out. In-house clinical data on heat, outpatient and inpatient care were analyzed.ResultsThe literature search on children and heat showed that heat-related illnesses in children, such as dehydration, are being observed with increasing frequency. Our own data show that heat-related illnesses are also recorded in the pediatric clinic, especially in years with heat waves.DiscussionHeat exposure during pregnancy leads to a lower birth weight and more premature births. Globally, the health of one third of the children worldwide are at risk from heat waves. In the future, depending on the climate scenario, increasing migration will be a consequence that will also strongly affect future generations, i.e., today’s children, in Germany.
... There is a growing literature in both epidemiology and economics on the excess morbidity and mortality associated with exposure to extreme temperatures (Banerjee & Maharaj, 2020;Mullins & White, 2020;Sekhri & Storeygard, 2014;Watts et al., 2019). Extremely hot or cold days can overload the human body's thermoregulatory system, reducing organ and tissue function and aggravating illness or even causing death (Huang et al., 2012;Longden, 2019). ...
Extreme temperatures are known to cause adverse health outcomes. Yet knowledge on the magnitude of this effect in developing countries is limited due to data availability and reliability issues. Collecting data for 2872 counties in China, we estimate the effects of daily temperatures on the monthly mortality rate. The results indicate that an additional day for which the maximum temperature is 38°C or above on average increases the monthly mortality rate by about 1.7% relative to if that day's maximum temperature had been in the range 16–21°C. This is after deducting deaths harvested from the subsequent month. Higher gross domestic product per capita at the county level is associated with lower mortality effects of hot and cold days. Improved dwelling conditions are found to be associated with a lower mortality effect of hot days and improved local healthcare infrastructure to be associated with a lower mortality effect of cold days. In the absence of strong adaptation efforts, the estimates suggest net upward pressure on annual mortality rates over coming decades in many populous counties, especially under more extreme climate change scenarios.
... Driven by climate change, extreme meteorological events (e.g., heatwave, flood, and thunderstorm) are likely to increase in frequency and severity [9,10]. It has been well established that long-term or short-term exposure to non-optimum temperatures are associated with the increase of mortality and cardiovascular morbidity [11,12]. ...
Background
In the context of climate change, it has been well observed that short-term temperature variability (TV) could increase the overall and cause-specific mortality and morbidity. However, the association between long-term TV and a broader spectrum of diseases is not yet well understood, especially in the elderly.
Methods
Our study used data from the fourth Urban and Rural Elderly Population (UREP) study. Long-term TV was calculated from the standard deviation (SD) of daily minimum and maximum temperatures within the study periods (2010–2014, 2011–2014, 2012–2014, 2013–2014, and 2014). Ten self-reported diseases and conditions were collected by questionnaire, including cataract, hypertension, diabetes, cardio-cerebrovascular diseases, stomach diseases, arthritis, chronic lung disease, asthma, cancer, and reproductive diseases. The province-stratified logistic regression model was used to quantify the association between long-term TV and the prevalence of each disease.
Results
A total of 184,047 participants were included in our study. In general, there were significant associations between TV and the prevalence of most diseases at the national level. Cardio-cerebrovascular disease (OR: 1.16, 95% CI: 1.13, 1.20) generated the highest estimates, followed by stomach diseases (OR: 1.15, 95% CI: 1.10, 1.19), asthma (OR: 1.14, 95% CI: 1.06, 1.22), chronic lung diseases (OR: 1.08, 95% CI: 1.03, 1.13), arthritis (OR: 1.08, 95% CI: 1.05, 1.11), and cataract (OR: 1.06, 95% CI: 1.02, 1.10). Moreover, the associations varied by geographical regions and across subgroups stratified by sex, household income, physical activity, and education.
Conclusions
Our study showed that long-term exposure to TV was associated with the prevalence of main diseases in the elderly. More attention should be paid to the elderly and targeted strategies should be implemented, such as an early warning system.
... According to Tan and Abdul-Samad (2022), extreme temperature events would decrease labor force and hinder construction projects. The workforce reduction will hinder progress, shut down operations, reduce work efficiency, and decrease labor productivity (Gasparrini et al., 2015;Morabito et al., 2017;Dosio et al., 2018;Watts et al., 2019). So, temperature anomalies can make the construction industry more vulnerable to adverse circumstances. ...
Climate change increases the frequency of extreme climate events and impacts the economy and the society in a negative way. As typical climate events, temperature anomalies affect individual health and working conditions, particularly for industries that depend heavily on temperatures. Using a research setting of Chinese temperature-sensitive enterprises, we analyze the impact of temperature on labor productivity. The findings indicate an inverse U-shaped relationship between temperature and labor productivity, with labor productivity peaking at 24.90°C on average. Further analysis shows that labor productivity peaks in the eastern regions at a higher level (26.25°C) than in the central and western regions (20°C). Moreover, we note that technological innovation is crucial for enterprises to manage climate risks and maintain effective labor productivity. This study provides empirical evidence on the relationship between environmental risk and corporate operations, shedding light on the significance of corporate sustainable development against accelerating global climate change.
... In 2018 alone, US health care emissions resulted in a loss of almost 400,000 disability-adjusted life years [1]. Efforts to mitigate the adverse impacts of health care pollution must include the supply chain, which contributes about 80% of total US health sector GHG emissions on a life cycle basis from natural resource extraction, manufacturing, packaging, transportation, and eventual waste disposal management [1][2][3][4][5]. ...
Background
The United States health care sector is one of the largest polluting industries, which has significant adverse effects on human health. Medical device reprocessing (MDR) is a sustainability solution that has the potential to decrease hospital waste, cut carbon emissions, reduce spending, and improve supply chain resiliency; however, only a small proportion of FDA-approved devices are actually reprocessed. Thus, we conducted a qualitative study to understand barriers and facilitators of scaling up MDR.
Methods and findings
We conducted in-depth interviews with 17 stakeholders (exceeding thematic saturation) at a large academic health system in New England and national MDR organizations. We also collected observations through site visits at the health system. We recruited participants from June 2021 to April 2022 through purposive sampling. Using an analytic approach guided by the Consolidated Framework for Implementation Research, we applied inductive and deductive codes related to key implementation constructs. We then conducted a thematic analysis and identified five overarching themes related to barriers and facilitators of MDR. First, respondents explained that regulatory bodies and original equipment manufacturers determine which devices can be reprocessed. For example, some respondents described that original equipment manufacturers use tactics of forced obsolescence that prevent their devices from being reprocessed. Second, respondents explained that MDR has variable compatibility with hospital priorities; for example, the potential cost savings of MDR is compatible with their priorities, while the perception of decreased functionality of reprocessed medical devices is incompatible. Third, respondents described that physician preferences influence which reprocessed devices get ordered. Fourth, respondents explained that variable staff knowledge and beliefs about MDR influence their motivations to select and collect reprocessable devices. Lastly, respondents emphasized that there was a lack of infrastructure for evaluating and maintaining MDR programs within their health system.
Conclusions
Based on our findings, we have outlined a number of recommendations that target these barriers and facilitators so that the environmental and financial benefits of MDR can be realized at this health system and nationally. For example, implementing federal policies that prevent original equipment manufacturers from using tactics of forced obsolescence can facilitate the scale-up of MDR nationally. Additionally, providing life cycle assessments that compare the environmental effects of single-use disposable, reprocessable disposable, and reusable devices could facilitate health systems’ purchasing decisions. Creating and disseminating audit and feedback reports to hospital staff might also facilitate their continued engagement in the program. Lastly, hiring a full-time program manager that leads MDR programs within health systems could improve program sustainability.
... Increasingly, hospitals are engaging in environmental stewardship 58 and international leaders are committing to climate change adaptation and mitigation in healthcare. 1,59 Now, more than ever, action is not only due, but also possible. ...
Climate change poses significant threats to human health and society. Although healthcare will bear a large burden of the downstream effects of climate change, the healthcare industry is simultaneously a major contributor to climate change. Within hospitals, surgery is one of the most energy-intensive practices. There is a growing body of literature describing ways to mitigate and adapt to climate change in surgery. However, there is a need to better understand the unique implications for each surgical subspecialty. This review contextualizes plastic and reconstructive surgery within the climate change discussion. In particular, this review highlights the specific ways in which plastic surgery may affect climate change and how climate change may affect plastic surgery. In light of growing public demand for change and greater alignment between industries and nations with regard to climate change solutions, we also offer a conceptual framework to guide further work in this burgeoning field of research.
... Similar to our results, several reports indicated that both low and high temperatures were associated with increases in cardiovascular disease mortality and constituted among the largest global environmental risk factors for premature mortality [6][7][8]13]. A previous study suggested that, globally, 596.8 thousand deaths from IHD were attributable to suboptimal temperature (including 555.5 thousand deaths attributed to low temperature and 43.300 thousand deaths attributed to high temperature) [7]. ...
... On the other hand, a rise of temperature had a substantial effect in populations with a lesser ability to adapt to temperature changes, especially in countries with limited socio-economic resources, which can worsen health inequalities in the world [14,15]. Among others, based on the link between non-optimal temperature and stroke mortality, the Lancet Countdown on health and climate change concluded that the response to climate change could be "the greatest global health opportunity of the 21st century" [16]. ...
... Climate change is one of the greatest global challenges for humans and their entire living environment in the 21st century. It has been at the center of various social and research disciplines, from economics (Hertel and Rosch, 2010) and animal welfare (Lacetera, 2019) to land management and food security (Shukla et al., 2019), with a particular attention to the human health domain (Peters and Schneider, 2021;Vicedo-Cabrera et al., 2021;Watts et al., 2019). Near surface air temperature (T air ) is one of the most important meteorological parameters and a key indicator of climate change. ...
The commonly used weather stations cannot fully capture the spatiotemporal variability of near-surface air temperature (Tair), leading to exposure misclassification and biased health effect estimates. We aimed to improve the spatiotemporal coverage of Tair data in Germany by using multi-stage modeling to estimate daily 1 × 1 km minimum (Tmin), mean (Tmean), maximum (Tmax) Tair and diurnal Tair range during 2000-2020. We used weather station Tair observations, satellite-based land surface temperature (LST), elevation, vegetation and various land use predictors. In the first stage, we built a linear mixed model with daily random intercepts and slopes for LST adjusted for several spatial predictors to estimate Tair from cells with both Tair and LST available. In the second stage, we used this model to predict Tair for cells with only LST available. In the third stage, we regressed the second stage predictions against interpolated Tair values to obtain Tair countrywide. All models achieved high accuracy (0.91 ≤ R2 ≤ 0.98) and low errors (1.03 °C ≤ Root Mean Square Error (RMSE) ≤ 2.02 °C). Validation with external data confirmed the good performance, locally, i.e., in Augsburg for all models (0.74 ≤ R2 ≤ 0.99, 0.87 °C ≤ RMSE ≤2.05 °C) and countrywide, for the Tmean model (0.71 ≤ R2 ≤ 0.99, 0.79 °C ≤ RMSE ≤1.19 °C). Annual Tmean averages ranged from 8.56 °C to 10.42 °C with the years beyond 2016 being constantly hotter than the 21-year average. The spatial variability within Germany exceeded 15 °C annually on average following patterns including mountains, rivers and urbanization. Using a case study, we showed that modeling leads to broader Tair variability representation for exposure assessment of participants in health cohorts. Our results indicate the proposed models as suitable for estimating nationwide Tair at high resolution. Our product is critical for temperature-based epidemiological studies and is also available for other research purposes.
Currently, few robust data are available to provide estimates of the environmental footprint and in particular the CO2 emissions of medical devices; however, existing life cycle assessments largely indicate that reusable materials have more favorable emissions and environmental footprints compared to disposable items. Thus, the challenge for every anesthesiology department is to identify items that can be used as reusable products for ecological and other reasons.A prerequisite for the use of reusable items is hygienically correct reprocessing and packaging. Here, a distinction must be made between noncritical, semicritical and critical medical devices, depending on the type of use. In addition, a distinction must be made between categories A-C, depending on the complexity of the reprocessing.In this narrative review article common reusable items used in anesthesiology are categorized and a standardized decision algorithm for reprocessing routes is proposed. Special attention is also given to the packaging of medical devices, which can contribute to the ecological footprint to a relevant extent.This article further explains the framework under which reprocessing can take place and analyzes the current state of knowledge on the life cycle assessment of reprocessing reusable devices.This requires the special commitment of clinically active anesthesiologists to include ecological aspects in the decision to use disposable or reusable items. In the medium term, comprehensible ecological key numbers should be provided on every medical device to make the ecological costs of the articles understandable in addition to the monetary costs.
Policy measures refer to all phases of the disaster cycle: pre-disaster, response, and post-disaster. The biggest reform involves the pre-disaster phase where considerable resources will need to be invested in prevention—mobilizing funds, securing investments for disaster risk reduction, and building capacities for response and monitoring. The time of reconstruction overlaps with the pre-disaster phase as new events will need to be anticipated and there is the need to build back better. With more frequent shocks, countries also need to check on the capability of their systems to withstand multiple shocks, with strengthened capacities, lifelines, and infrastructure. There needs to be resource mobilization ahead of disasters. Coordination is vital to addressing local gaps in response and to avoid duplication of efforts and wastage.KeywordsAdaptationMitigationDisaster ManagementTaxesSubsidiesFinancing
The factors and processes that enable child and youth resilience vary across situational and cultural contexts. Even so, many studies of resilience theorize positive adaptation in contextually neutral ways and/or perpetuate resilience accounts that mirror minority world realities. To discourage a continuation of that problematic tendency, this chapter advances an understanding of resilience enablers that are responsive not only to risks but also to social–ecological or contextual dynamics. Drawing mostly on studies of child and youth resilience in majority world contexts, this chapter interrogates resilience enablers’ fit with specific social ecologies, explores unconventional adaptive strategies, and probes the need for resilience enablers to accommodate changing contextual realities. This more nuanced construction of protective factors and processes informs a culturally responsible understanding of resilience and animates strategies towards decolonized theories of successful adaptation to significant stress.
An effort is made to understand the role of El Nino-Southern Oscillation (ENSO) and Indian Ocean Dipole (IOD) events on the malaria transmission intensity over India during the period 1951–2020 (70 years) with the help of a realistically simulated dynamical malaria model. The results suggest that the La Nina years pose a greater threat of malaria disease, especially in the densely populated Indian states. During El Nino years, the malaria transmission intensity and distribution over India greatly reduce, except in the regions such as Orissa, Chhattisgarh, Jharkhand, Western Ghats, parts of Madhya Pradesh, and Andhra Pradesh. It is found that in the positive IOD years, the malaria transmission intensity increases (decreases) over the entire central Indian region and along coastal regions of Tamil Nadu and Kerala (southern peninsular states of India and northeast India). An almost opposite behavior is seen during the negative IOD years. The malaria transmission variability over India is becoming increasingly heterogeneous in recent decades during the El Nino and La Nina years as a result of global warming. The period of 1986–2020 witnessed a substantial decrease (increase) in the malaria transmission intensity during the positive (negative) IOD years, except for a few regions of India. The implications of the results presented in the paper linking the ENSO and IOD signals with the intensity and distribution of malaria over India in a warming world are enormous, especially for the densely populated Indian states.
Introduction: Global climate change, which is characterized by climate warming,
has become one of the most prominent risk problems in society at present. Climate
migration brings many accompanying problems to the environment, economy,
politics, society, and culture. It is of great theoretical and practical significance to
study the internal relationship between climate change and population migration.
Methods: The data were extracted from the Web of Science core collection
database (WOS) and China Knowledge Network database (CNKI). A total of 785
documents and 157 documents in the field of climate migration from 2008 to
2021 were selected as analysis samples. Word frequency analysis, clustering
analysis, sudden word detection analysis, and other methods were extensively
used to build the evolution trend map of climate migration using CiteSpace visual
bibliometric software.
Results: It is concluded that climate migration research has experienced three
stages of development: initial exploration stage (2008-2011), development
enrichment stage (2012-2017), and system deepening stage (2018).The hot topics
of climate migration include: (1) different types of climate migration research; (2)
Quantitative model research on climate migration; (3) Climate justice research.
Different types of climate migration include 7 main types: (1) migration caused
by sea level rise; (2) Resettlement caused by flood disaster; (3) Migration due to
worsening drought; (4) Migration caused by extreme climate events; (5) Voluntary
migration due to climate change discomfort; (6) Project resettlement caused by
climate change response engineering measures; (7) Migrants whose livelihoods
are broken due to climate change.
Discussion: The study points out that climate migration research is an
interdisciplinary research field, which needs joint research by scholars from
different academic backgrounds. In the future climate migration research,
1) strengthen the prediction ability of climate change population migration
model; 2) Make use of China’s beneficial exploration in the migration fields such
as engineering resettlement, ecological resettlement and poverty alleviation
resettlement to formulate climate migration policies, regulations and strategic
planning; 3) Establish a database cloud platform related to climate change and
population migration; 4) Strengthen the exchange and cooperation between
Chinese researchers in the field of climate migration and international scientific
research institutions.
Physicians play an important role in adapting to and mitigating the adverse health effects of the unfolding climate and ecological crises. To fully harness this potential, future physicians need to acquire knowledge, values, skills, and leadership attributes to care for patients presenting with environmental change-related conditions and to initiate and propel transformative change in healthcare and other sectors of society including, but not limited to, the decarbonization of healthcare systems, the transition to renewable energies and the transformation of transport and food systems. Despite the potential of Planetary Health Education (PHE) to support medical students in becoming agents of change, best-practice examples of mainstreaming PHE in medical curricula remain scarce both in Germany and internationally. The process of revising and updating the Medical Licensing Regulations and the National Competency-based Catalog of Learning Objectives for Medical Education in Germany provided a window of opportunity to address this implementation challenge. In this article, we describe the development and content of national Planetary Health learning objectives for Germany. We anticipate that the learning objectives will stimulate the development and implementation of innovative Planetary Health teaching, learning and exam formats in medical schools and inform similar initiatives in other health professions. The availability of Planetary Health learning objectives in other countries will provide opportunities for cross-country and interdisciplinary exchange of experiences and validation of content, thus supporting the consolidation of Planetary Health learning objectives and the improvement of PHE for all health professionals globally.
Background
Global health will increasingly be determined by cities. Currently over half of the world’s population, over 4 billion people, live in cities. This systematic scoping review has been conducted to understand what cities are doing to improve health and healthcare for their populations.
Methods
We conducted a systematic search to identify literature on city-wide initiatives to improve health. The study was conducted in accordance with PRISMA and the protocol was registered with PROSPERO (CRD42020166210).
Results
The search identified 42,137 original citations, yielding 1,614 papers across 227 cities meeting the inclusion criteria. The results show the majority of initiatives were targeted at non-communicable diseases. City health departments are making an increasing contribution however the role of mayors appears to be limited.
Conclusion
The collective body of evidence identified in this review, built up over the last 130 years, has hitherto been poorly documented and characterised. Cities are a meta-system with population health dictated by multiple interactions and multidirectional feedback loops. Improving health in cities requires multiple actions, by multiple actors, at every level. The authors use the term ‘The Vital 5’. They are the 5 most important health risk factors; tobacco use; harmful alcohol use; physical-inactivity, unhealthy diet and planetary health. These ‘Vital 5’ are most concentrated in deprived areas and show the greatest increase is in low and middle income countries. Every city should develop a comprehensive strategy and action plan to address these ‘Vital 5’
Global warming is a result of the increased emission of greenhouse gases. This climate change consequence threatens society, biodiversity, food and resource availability. The consequences in health involve the increased risk of cardiovascular (CV) disease and cardiovascular mortality.In this position paper we summarize the data from the main studies that assessed the risks of temperature increase or heat waves in CV events (CV mortality, myocardial infarction, heart failure, stroke, and CV hospitalizations), as well as the data concerning air pollution as an enhancer of temperature-related CV risks. The data currently supports that global warming / heat waves (extreme temperatures) are cardiovascular threats. Achieving the neutrality in the emissions to prevent global warming is essential and it is likely to have an effect in the global health, including the cardiovascular health. Simultaneously, urgent step are required to adapt the society and individual to this new climate context potentially harmful for the cardiovascular health. Multidisciplinary teams should plan and intervene in heat-related healthcare and advocate for environmental health policy change.
Introduction:
This study describes the development and validation of structure indicators for clinical infectious disease (ID) care in German hospitals, which is important to adequately face the future challenges in ID medicine.
Methods:
A team of experts developed the structure indicators in a three-stage, multicriteria decision-making process: (1) identification of potential structure indicators based on a literature review, (2) written assessment process, and (3) face-to-face discussion to reach consensus and final selection of appropriate structure indicators. A field study was conducted to assess the developed structure indicators. A score based on the structure indicators was determined for each hospital and validated via receiver operator characteristic (ROC) curves using externally validated ID expertise (German Society of ID (DGI) Centre).
Results:
Based on a list of 45 potential structure indicators, 18 suitable indicators were developed for clinical ID care structures in German hospitals. Out of these, ten key indicators were defined for the general and coronavirus disease 2019- (COVID-19-) specific clinical ID care structures. In the field survey of clinical ID care provision for COVID-19 patients in 40 German hospitals, the participating facilities achieved 0 to 9 points (median 4) in the determined score. The area under the ROC curve was 0.893 (95% CI: 0.797, 0.988; p < 0.001).
Discussion/conclusion:
The structure indicators developed within the framework of a transparent and established development process can be used in the future to both capture the current state and future developments of ID care quality in Germany and enable comparisons.
Health systems have a duty to protect the health and well-being of individuals and populations. Yet, healthcare contributes about 4.6% of global greenhouse gas emissions. Health systems need to question and improve established practices, assume strong environmental leadership, and aim for ambitious, sometimes radical, actions in favour of the climate. In this paper, we interrogate the suitability and feasibility of integrating the aim of 'environmental sustainability' to form the 'Sextuple Aim.' Environmental sustainability may be in tension with, but also a potential lever to meet the other cardinal aims: (1) quality and experience of patient care; (2) population health; (3) quality of work and satisfaction of healthcare providers; (4) equity and inclusion; and (5) cost reduction. We propose policy and practical avenues to help move towards the Sextuple Aim.
Healthcare contributes to environmental harm. Trainee-led Research and Audit in Anaesthesia for Sustainable Healthcare (TRA 2 SH) is an Australasian network focused on sustainable anaesthesia practice. TRA 2 SH hypothesised that trainee-led audits alongside education presented on a scheduled national day, called Operation Clean Up, can improve engagement with sustainability initiatives. This paper aims to describe the first two years of Operation Clean Up in terms of goals, achievements and data collected so far. Environmental themes for Operation Clean Up were chosen based on available evidence (life cycle analyses and observational studies). The first Operation Clean Up (OCU 2020) focused on reducing the unnecessary use of single-use disposable absorbent pads (known as ‘blueys’ in Australia, ‘greenies’ in New Zealand). OCU 2021 included: refuse desflurane, reduce bluey use, reuse drug trays, and recycle paper and cardboard. TRA 2 SH provided an information pack to trainees who presented educational material to their department and fed back procurement figures to quantify each item. Descriptive statistics were used to analyse de-identified pooled data submitted to a centralised database.
Eight departments submitted data for OCU 2020 and six provided follow-up data. Bluey use was reduced from a median of 37 to 34 blueys per ten surgical encounters. Fifteen departments submitted pre-campaign data for OCU 2021 with follow-up data to be collected during OCU 2022. Baseline data showed a median bluey use of 31 per ten surgical encounters. Volatile-related emissions were calculated; desflurane’s proportion was 70% of these emissions yet was 11% of volatile procurement. Two participating departments removed desflurane from their formulary following OCU 2021. Operation Clean Up is a practical model for implementing sustainability initiatives using trainees as eco-leaders.
Fortbestehender hoher Ressourcenverbrauch bedingt die Überschreitung der planetaren Belastungsgrenzen; moderne Gesundheitssysteme tragen zu dieser Problematik bei. Um dies zu adressieren, bietet dieser Artikel eine Übersicht zu ausgewählten Aspekten nachhaltiger Maßnahmen in Praxis und Klinik, die auch für die Dermatologie von Relevanz sind. Konkrete Handlungsfelder liegen im
Bereich energetischer und baulicher Maßnahmen, Verkehr und Mobilität, Praxisorganisation inklusive Digitalisierung sowie Personal und Evaluation. Weiterhin werden in diesem Artikel spezielle Aspekte der Hygiene und Reinigung, Dermatochirurgie
und Verordnungsverhalten beleuchtet. Externa und Kosmetika werden hierbei gesondert diskutiert, da diese in der ermatologie eine Sonderstellung einnehmen. Darüber hinaus werden Informationen zu bereits etablierten nachhaltigen
Initiativen im Gesundheitswesen zusammengestellt. Ziel des Artikels ist es, zur Reflexion gängiger ärztlicher Praxis und zur Implementation nachhaltiger Maßnahmen anzuregen.
Ongoing high consumption of resources leads to exceeding the planetary
boundaries. Modern healthcare systems contribute to this problem. To address
this matter, this article renders an overview of various aspects of sustainable
actions in medical offices and clinics, which can be applied to dermatology as
well. Specific fields of action include energy consumption, structural measures,
traffic and mobility, organization including digitalization as well as personnel and
evaluation. Moreover, we discuss specific topics such as hygiene and cleansing,
dermatosurgery and prescription practices. External treatments and cosmetics are
discussed separately as dermatological peculiarities. Finally, we provide information
on established initiatives for a more sustainable health care in Germany. We
aim to encourage a critical reappraisal of presently established practices and to
stimulate an implementation of sustainable measures.
The concept of the early life developmental origins of health and disease (DOHaD) in adults has stimulated a new approach to understanding disease trajectories, with major public health implications. Indeed, the principle of the 'lifecourse of disease' now influences health policies internationally. Environmental influences during pregnancy and early life that affect lifelong health are well documented, but there is a new focus on the preconception period and the significance of paternal health on the fetus. This fully revised second edition highlights scientific and clinical advances in the field, exploring new understanding of mechanisms such as epigenetics and the increasingly recognised role of external influences, including pollution. The book is structured logically, covering environment, clinical outcomes, mechanisms of DOHaD, interventions throughout the lifespan and finally implications for public health and policy. Clinicians and scientists alike will improve their understanding of the developmental origins of health and disease with this essential text.
White explores several contentious issues pertaining to the theory and practice of Environmental Restorative Justice (ERJ), beginning with consideration of how justice might be construed in relation to non-human environmental entities such as rivers, trees, birds and mountains. The chapter argues that is essential to frame ERJ in terms of situationally relevant strengths and limitations. For example, it examines how ERJ processes are used in New Zealand, but in institutional forums that tend to downplay the criminal nature of the harm, treating it more as a civil matter. By contrast, the chapter also considers how ‘repairing the harm’ does not always depend upon restorative justice processes and procedures, particularly in regards crimes of the powerful such as corporations, although criminal justice responses can still reflect some of the overarching principles of restorative justice. The chapter also addresses significant issues pertaining to who should speak about or for Nature in the context of ERJ processes, and the frameworks which circumscribe and/or facilitate this.
Purpose of Review
The climate change (CC) or global warming (GW) modifies environment that favors vectors’ abundance, growth, and reproduction, and consequently, the rate of development of pathogens within the vectors. This review highlights the threats of GW-induced vector-borne diseases (VBDs) in Southern Europe (SE) and the need for mitigation efforts to prevent potential global health catastrophe.
Recent Findings
Reports showed astronomical surges in the incidences of CC-induced VBDs in the SE. The recently (2022) reported first cases of African swine fever in Northern Italy and West Nile fever in SE are linked to the CC-modified environmental conditions that support vectors and pathogens’ growth and development, and disease transmission.
Summary
VBDs endemic to the tropics are increasingly becoming a major health challenge in the SE, a temperate region, due to the favorable environmental conditions caused by CC/GW that support vectors and pathogens’ biology in the previously non-endemic temperate regions.
Rapid changes in the global climate are deepening existing health disparities from resource scarcity and malnutrition. Rising ambient temperatures represent an imminent risk to pregnant women and infants. Both maternal malnutrition and heat stress during pregnancy contribute to poor fetal growth, the leading cause of diminished child development in low-resource settings. However, studies explicitly examining interactions between these two important environmental factors are lacking. We leveraged maternal and neonatal anthropometry data from a randomized controlled trial focused on improving preconception maternal nutrition (Women First Preconception Nutrition trial) conducted in Thatta, Pakistan, where both nutritional deficits and heat stress are prevalent. Multiple linear regression of ambient temperature and neonatal anthropometry at birth (n = 459) showed a negative association between daily maximal temperatures in the first trimester and Z-scores of birth length and head circumference. Placental mRNA-sequencing and protein analysis showed transcriptomic changes in protein translation, ribosomal proteins, and mTORC1 signaling components in term placenta exposed to excessive heat in the first trimester. Targeted metabolomic analysis indicated ambient temperature associated alterations in maternal circulation with decreases in choline concentrations. Notably, negative impacts of heat on birth length were in part mitigated in women randomized to comprehensive maternal nutritional supplementation before pregnancy suggesting potential interactions between heat stress and nutritional status of the mother. Collectively, the findings bridge critical gaps in our current understanding of how maternal nutrition may provide resilience against adverse effects of heat stress in pregnancy.
The excessive growth of the health sector has created an industry that, while promoting health, is now itself responsible for a significant part of global environmental pollution. The health crisis caused by climate change urges us to transform healthcare into a sustainable industry. This review aims to raise awareness about this issue and to provide practical and evidence-based recommendations for anaesthesiologists. We offer seven recommendations for anaesthesiologists that want to transform their own practice. Use total intravenous anaesthesia over inhalation-based anaesthesia. Use ultra-low fresh gas flow (<0.5 l min−1) during inhalation based anaesthesia and higher flows (4–6 l min−1) during total intravenous anaesthesia. Anaesthetic gas capturing technology may have limited environmental benefit, while it increases cost. In the clinical setting, epidural or intravenous analgesia during labour is preferred over nitrous oxide inhalation. Properly designed air treatment systems save energy and reduce cost. Unoccupied set-back of air treatment systems can save up to 70% of energy. Reusable equipment is almost always associated with a lower environmental impact and lower costs compared with single-use disposables. This review offers evidence-based recommendations, along with their financial impact, to improve the sustainability of anaesthesiology practice in the operating room.
Background:
As a consequence of the climate crisis, a drastic reduction of greenhouse gas emissions and a transformation towards a sustainable economy are indispensable for the health care sector.
Methods:
For the present study, barriers and facilitators in implementing a transformation towards more sustainability were evaluated in qualitative interviews with members of an initiative attempting to establish more sustainability at a general hospital.
Results:
In 12 interviews, the interviewees were asked about the necessary personal characteristics for their commitment, short- and long-term ideas about how to reduce green house gas emissions, as well as barriers and facilitators of the organization's structure and of the societal context.
Conclusion:
The methods for implementing more sustainability at a general hospital are mostly known. However, more knowledge is needed about the capacity to withstand both organizational barriers and feelings of hopelessness and impotence in order to preserve one's ability to act.
Floating offshore wind power, an emerging technology in the offshore wind industry, has attracted increasing attention for its potential to cooperate with other renewable energies to decarbonize energy systems. The environmental effects of the floating offshore wind farm in deep-sea areas should be considered, and methods to enhance the low-carbon effect should be devised. There have been a few studies assessing the environmental effects of the floating offshore wind farm, but the scales of these studies were relatively small. This study evaluated the environmental impacts of a floating wind farm with 100 wind turbines of 6.7 MW using life cycle assessment (LCA) method, based on the Chinese core life cycle database. Results showed that the carbon footprint of the wind farm was 25.76 g CO2-eq/kWh, which was relatively low in terms of global warming potential. Additionally, the floating offshore wind farm contributed most to eutrophication potential. A ± 20% variation in steel resulted in a ±3% to ±15% variation in the indicator score of each environmental category, indicating that the environmental performance of the wind farm was mainly influenced by this parameter. Moreover, scenario analysis showed that electric arc furnace routes can reduce the cumulative greenhouse gas emissions from upstream process of the floating offshore wind farm by 1.75 Mt CO2-eq by 2030. Emission reduction of the steel industry will further reduce the carbon footprint of the floating offshore wind farm. In the future, more baseline data need to be collected to improve the reliability of LCA. The effects of the floating offshore wind farm on marine ecology and atmospheric physical characteristics remain to be investigated in depth.
Climate change‐related eco‐anxiety in young people has made headlines around the world, but most study of this phenomenon has been limited to adults. Eco‐anxiety is still not well defined in the literature, but generally refers to distress, worry, or concern related to the climate change crisis. Young people will be chronologically more exposed to climate change‐related harms and problems, and this may be causing increased eco‐anxiety in this population. This literature review aimed to summarize the relevant works on eco‐anxiety in young people, provide a critique of the literature, identify gaps, and discuss the relevance to nursing practice. A literature search using multiple databases and other sources was completed, using applicable key terms and resulted in 23 sources to inform the review. Key themes of eco‐anxiety definition variation, hopelessness and burden in young people, and responses to eco‐anxiety are discussed, and critical analysis is undertaken. The main conclusions include a broad working definition of eco‐anxiety that does not pathologize the eco‐anxiety experience but recognizes that it can cause suffering. Also discussed is the role of nurses in reducing the potential or actual suffering of youth through hope promotion, challenging binary thinking patterns, building emotional resilience, encouraging action or involvement in climate change spheres, and promoting climate justice and advocacy. Recommendations for further research are offered.
This study attempts to understand the role of the nonprofit sector within the climate change discourse in Russian news media. It explores the news media coverage of climate change and nonprofit sector through the quantitative review of Russian news articles published within the five-year period of 2016–2021. We find that the nonprofit sector generally gains positive media coverage, and the climate change is presented as mostly a national and political issue, while the scientific discussions are very rare. Government and nongovernment news media sources diverge in their coverage on the topic. The state-owned media views the climate change as a national issue relying predominantly on Russian official sources, and praising assistance that the Russian government provides to the nonprofit sector. On the other hand, the nongovernment media highlights the political aspects of the climate change, includes government critique, and often draw on business and foreign sources.
Natural resources benefit economies through economic growth and development. However, continuing unsustainable exploitation of these resources tends to harm the sustainability of the environment. Therefore, this paper explores the role of environmental regulatory quality (ERQ) in the relationship between natural resources (NR) and environmental sustainability (ES). The study covered 28 sub-Saharan African countries (SSA) from 2005-2017. Regarding the estimations, we utilized cross-sectional dependence, first-and second-generation unit root, and cointegration tests for preliminary checks. Finally, we used the system-GMM estimation for the analysis. We found that environmental regulatory quality improves environmental sustainability in SSA. We also observed that natural resources degrade environmental sustainability. Furthermore, we noticed that natural resources complemented environmental regulatory quality to reduce environmental sustainability in SSA. Therefore, we establish that ERQ in SSA does not complement NR to induce environmental sustainability. Based on the findings, we appeal for effective and rigorous implementation of environmental policies and regulations in SSA.
Background:
The environmental impact of reusable and disposable devices is unclear; reuse is expected to reduce the carbon footprint, but the environmental impact of reprocessing of reusable devices is increasingly being questioned.
Objective:
The aim was to provide the first rigorous life cycle assessment of reusable and disposable flexible cystoscopes.
Design, setting, and participants:
We performed a life cycle assessment of reusable flexible cystoscopes and the aS4C single-use cystoscope (aScope; Ambu, Ballerup, Denmark). For the aScope, the complete lifespan of the scope was evaluated, including raw material extraction, material formulation, component production, product assembly, distribution, transportation after use, and final disposal. For reusable cystoscopes, we limited our analysis to their reprocessing, using a model consisting of standard high-level disinfection with peracetic acid. The environmental impact was evaluated by an independent third-party consulting company APESA (Technopole Hélioparc, Pau, France) dedicated to such risk assessments.
Outcome measurements and statistical analysis:
The environmental footprint of both cystoscopes was assessed using five environmental impact categories, namely, climate change, mineral resource depletion, ecotoxicity, acidification, and eutrophication. To perform the life cycle assessment, Simapro v9.3.3 software was used and the Ecoinvent v3.5 database was employed as the primary life cycle inventory database. A Monte Carlo analysis was used to account for the inherent uncertainty in life cycle inventory data and the variability in material and energy consumption for each type of flexible cystoscope.
Results and limitations:
By only comparing the disinfection reprocessing of reusable cystoscopes with the complete lifespan of the single-use cystoscope, the use of the aScope would allow a reduction of at least 33% in the climate change category, 50% in the mineral resources' depletion category, 51% in the ecotoxicity category, 71% in the acidification category, and 49% in the eutrophication category. Our results cannot be generalized to all health care facilities as we studied only one type of reprocessing method and one disposable flexible cystoscope.
Conclusions:
Disinfection reprocessing of reusable cystoscopes was found to have a significantly larger environmental footprint and impact than the whole lifespan of the single-use cystoscope aScope.
Patient summary:
Using a cradle-to-grave life cycle analysis, we showed that the environmental footprint of a flexible cystoscopy procedure can be reduced by using a disposable cystoscope instead of a reusable cystoscope.
Within the extensive scientific and policy discussions about climate change migrants, detailed analyses continue to highlight the lack of evidence thus far for climate change directly causing migration. To understand better how climate change might or might not lead to migration, this paper explores possibilities for developing a robust, repeatable, and verifiable method to count or calculate the number of people migrating or not migrating due to climate change. The discussion starts by examining definitions of “climate change” and “migration”, then looking at how to determine numbers of climate change migrants based on those definitions. These points lead to descriptions of the subjectivity and arbitrariness of the decisions needed for counting or calculating climate change migrants and non-migrants. While the scientific study of working out numbers of climate change migrants and non-migrants is challenging and interesting, especially due to its complexity, changing baselines alongside legitimate concerns about necessary assumptions lead to questions regarding the usefulness of the calculations for policy and action. Ultimately, labelling, counting, and calculating climate change migrants and non-migrants depend on political choices, so any numbers reached might not be scientifically robust. Improved understanding of people’s motivations for migrating and not migrating under different circumstances, including under climate change and perceptions thereof, would be preferable to a starting point assuming that climate change inevitably causes migration.
Climate change confronts the health care sector with a dual challenge. Accumulating climate impacts are putting an increased burden on the service provision of already stressed health care systems in many regions of the world. At the same time, the Paris agreement requires rapid emission reductions in all sectors of the global economy to stay well below the 2 C target. This study shows that in OECD countries, China, and India, health care on average accounts for 5% of the national CO2 footprint making the sector comparable in importance to the food sector. Some countries have seen reduced CO2 emissions related to health care despite growing expenditures since 2000, mirroring their economy wide emission trends. The average per capita health carbon footprint across the country sample in 2014 was 0.6 tCO2, varying between 1.51 tCO2/cap in the US and 0.06 tCO2/cap in India. A statistical analysis shows that the carbon intensity of the domestic energy system, the energy intensity of the domestic economy, and health care expenditure together explain half of the variance in per capita health carbon footprints. Our results indicate that important leverage points exist inside and outside the health sector. We discuss our findings in the context of the existing literature on the potentials and challenges of reducing GHG emissions in the health and energy sector.
The disease burden of dengue has been steadily rising over the last half-century due to a multitude of factors, including global trade and travel, urbanization, population growth, and climate variability and change, that facilitate conductive conditions for the proliferation of dengue vectors and viruses. This review describes how climate, specifically temperature, affects the vectors’ ability to cause and sustain outbreaks, and how the infectiousness of dengue is influenced by climatic change. The review is focused on the core concepts and frameworks derived in the area of epidemiology of mosquito-borne diseases and outlines the sensitivity of vectorial capacity and vector-to-human transmission on climatic conditions. It further reviews studies linking mathematical or statistical models of disease transmission to scenarios of projected climate change and provides recommendations for future research directions.
Background:
Occupational heat strain (ie, the effect of environmental heat stress on the body) directly threatens workers' ability to live healthy and productive lives. We estimated the effects of occupational heat strain on workers' health and productivity outcomes.
Methods:
Following PRISMA guidelines for this systematic review and meta-analysis, we searched PubMed and Embase from database inception to Feb 5, 2018, for relevant studies in any labour environment and at any level of occupational heat strain. No restrictions on language, workers' health status, or study design were applied. Occupational heat strain was defined using international health and safety guidelines and standards. We excluded studies that calculated effects using simulations or statistical models instead of actual measurements, and any grey literature. Risk of bias, data extraction, and sensitivity analysis were performed by two independent investigators. Six random-effects meta-analyses estimated the prevalence of occupational heat strain, kidney disease or acute kidney injury, productivity loss, core temperature, change in urine specific gravity, and odds of occupational heat strain occurring during or at the end of a work shift in heat stress conditions. The review protocol is available on PROSPERO, registration number CRD42017083271.
Findings:
Of 958 reports identified through our systematic search, 111 studies done in 30 countries, including 447 million workers from more than 40 different occupations, were eligible for analysis. Our meta-analyses showed that individuals working a single work shift under heat stress (defined as wet-bulb globe temperature beyond 22·0 or 24·8°C depending on work intensity) were 4·01 times (95% CI 2·45–6·58; nine studies with 11 582 workers) more likely to experience occupational heat strain than an individual working in thermoneutral conditions, while their core temperature was increased by 0·7°C (0·4–1·0; 17 studies with 1090 workers) and their urine specific gravity was increased by 14·5% (0·0031, 0·0014–0·0048; 14 studies with 691 workers). During or at the end of a work shift under heat stress, 35% (31–39; 33 studies with 13 088 workers) of workers experienced occupational heat strain, while 30% (21–39; 11 studies with 8076 workers) reported productivity losses. Finally, 15% (11–19; ten studies with 21 721 workers) of individuals who typically or frequently worked under heat stress (minimum of 6 h per day, 5 days per week, for 2 months of the year) experienced kidney disease or acute kidney injury. Overall, this analysis include a variety of populations, exposures, and occupations to comply with a wider adoption of evidence synthesis, but resulted in large heterogeneity in our meta-analyses. Grading of Recommendations, Assessment, Development and Evaluation analysis revealed moderate confidence for most results and very low confidence in two cases (average core temperature and change in urine specific gravity) due to studies being funded by industry.
Interpretation:
Occupational heat strain has important health and productivity outcomes and should be recognised as a public health problem. Concerted international action is needed to mitigate its effects in light of climate change and the anticipated rise in heat stress.
Funding:
EU Horizon 2020 research and innovation programme.
The following four key messages derive from the Lancet
Countdown’s 2018 report:
1 Present day changes in heat waves, labour capacity,
vector-borne disease, and food security provide early
warning of the compounded and overwhelming impact
on public health that are expected if temperatures
continue to rise. Trends in climate change impacts,
exposures, and vulnerabilities show an unacceptably
high level of risk for the current and future health of
populations across the world.
2 A lack of progress in reducing emissions and building
adaptive capacity threatens both human lives and the
viability of the national health systems they depend
on, with the potential to disrupt core public health
infrastructure and overwhelm health services.
3 Despite these delays, a number of sectors have seen
the beginning of a low-carbon transition, and it is
clear that the nature and scale of the response to
climate change will be the determining factor in
shaping the health of nations for centuries to come.
4 Ensuring a widespread understanding of climate
change as a central public health issue will be crucial
in delivering an accelerated response, with the health
profession beginning to rise to this challenge.
The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context.We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined.Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks.Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade.The Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
The development of the market has produced a differentiation inside the Chinese press between an ‘official’ press with traditional propaganda functions on behalf of the Communist Party and a ‘commercial’ press whose objective is to maximise revenue. Scholarly opinion has differed over whether marketization undermines Party control and whether new forms of journalism have arisen that lead to conflicts. These discussions have rested on little evidence as to the practises of Chinese journalism. This article presents empirical data on the extent of the differentiation, reporting on a content analysis of the national news in People’s Daily and Southern Metropolitan Daily. These titles are popularly believed to represent the polar opposites of official, orthodox journalism and commercial, liberal journalism. The evidence presented here demonstrates that while there are indeed significant differences in the journalism of the two titles, there remains a substantial overlap in their choice of subjects, their use of sources and the degree to which news is presented ‘objectively’. Southern Metropolitan Daily does display some ‘popular’ features and does contain more ‘watchdog’ journalism, but it shares with its official cousin an emphasis upon the party as the source for news.
Exposure to ambient fine particulate matter (PM2.5) is a major global health concern. Quantitative estimates of attributable mortality are based on disease-specific hazard ratio models that incorporate risk information from multiple PM2.5 sources (outdoor and indoor air pollution from use of solid fuels and secondhand and active smoking), requiring assumptions about equivalent exposure and toxicity. We relax these contentious assumptions by constructing a PM2.5-mortality hazard ratio function based only on cohort studies of outdoor air pollution that covers the global exposure range. We modeled the shape of the association between PM2.5 and nonaccidental mortality using data from 41 cohorts from 16 countries-the Global Exposure Mortality Model (GEMM). We then constructed GEMMs for five specific causes of death examined by the global burden of disease (GBD). The GEMM predicts 8.9 million [95% confidence interval (CI): 7.5-10.3] deaths in 2015, a figure 30% larger than that predicted by the sum of deaths among the five specific causes (6.9; 95% CI: 4.9-8.5) and 120% larger than the risk function used in the GBD (4.0; 95% CI: 3.3-4.8). Differences between the GEMM and GBD risk functions are larger for a 20% reduction in concentrations, with the GEMM predicting 220% higher excess deaths. These results suggest that PM2.5 exposure may be related to additional causes of death than the five considered by the GBD and that incorporation of risk information from other, nonoutdoor, particle sources leads to underestimation of disease burden, especially at higher concentrations.
Background
Human health is dependent upon environmental health. Air pollution is a leading cause of morbidity and mortality globally, and climate change has been identified as the single greatest public health threat of the 21st century. As a large, resource-intensive sector of the Canadian economy, healthcare itself contributes to pollutant emissions, both directly from facility and vehicle emissions and indirectly through the purchase of emissions-intensive goods and services. Together these are termed life cycle emissions. Here, we estimate the extent of healthcare-associated life cycle emissions as well as the public health damages they cause.
Methods and findings
We use a linked economic-environmental-epidemiological modeling framework to quantify pollutant emissions and their implications for public health, based on Canadian national healthcare expenditures over the period 2009–2015. Expenditures gathered by the Canadian Institute for Health Information (CIHI) are matched to sectors in a national environmentally extended input-output (EEIO) model to estimate emissions of greenhouse gases (GHGs) and >300 other pollutants. Damages to human health are then calculated using the IMPACT2002+ life cycle impact assessment model, considering uncertainty in the damage factors used. On a life cycle basis, Canada’s healthcare system was responsible for 33 million tonnes of carbon dioxide equivalents (CO2e), or 4.6% of the national total, as well as >200,000 tonnes of other pollutants. We link these emissions to a median estimate of 23,000 disability-adjusted life years (DALYs) lost annually from direct exposures to hazardous pollutants and from environmental changes caused by pollution, with an uncertainty range of 4,500–610,000 DALYs lost annually. A limitation of this national-level study is the use of aggregated data and multiple modeling steps to link healthcare expenditures to emissions to health damages. While informative on a national level, the applicability of these findings to guide decision-making at individual institutions is limited. Uncertainties related to national economic and environmental accounts, model representativeness, and classification of healthcare expenditures are discussed.
Conclusions
Our results for GHG emissions corroborate similar estimates for the United Kingdom, Australia, and the United States, with emissions from hospitals and pharmaceuticals being the most significant expenditure categories. Non-GHG emissions are responsible for the majority of health damages, predominantly related to particulate matter (PM). This work can guide efforts by Canadian healthcare professionals toward more sustainable practices.
Corals of the Great Barrier Reef (GBR) have declined over the past 30 years. While reef state depends on the balance between disturbance and recovery, most studies have focused on the effects of disturbance on reef decline. We show that coral recovery rates across the GBR declined by an average of 84% between 1992 and 2010. Recovery was variable: Some key coral types had close to zero recovery by the end of that period, whereas some reefs exhibited high recovery. Our results indicate that coral recovery is sensitive to chronic but manageable pressures, and is suppressed for several years following acute disturbances. Loss of recovery capacity was partly explained by the cumulative effects of chronic pressures including water quality, warming, and sublethal effects of acute disturbances (cyclones, outbreaks of crown-of-thorns starfish, and coral bleaching). Modeled projections indicate that recovery rates can respond rapidly to reductions in acute and chronic stressors, a result that is consistent with fast recovery observed on some reefs in the central and southern GBR since the end of the study period. A combination of local management actions to reduce chronic disturbances and global action to limit the effect of climate change is urgently required to sustain GBR coral cover and diversity.
Jaime Miranda and colleagues argue that partnerships are key to building and sustaining health research capacity in Latin America. © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to.
Computable general equilibrium (CGE) models are a standard tool for policy analysis and forecasts of economic growth. Unfortunately, due to computational constraints, many CGE models are dimensionally small, aggregating countries into an often limited set of regions or using assumptions such as static price-level expectations, where next period's price is conditional only on current or past prices. This is a concern for climate change modeling, since the effects of global warming by country, in a fully disaggregated and global trade model, are needed, and the known future effects of global warming should be included in forward-looking forecasts for prices and profitability. This work extends a large dimensional intertemporal CGE trade model to account for the various effects of global warming (e.g., loss in agricultural productivity, sea level rise, and health effects) on Gross Domestic Product (GDP) growth and levels for 139 countries, by decade and over the long term, where producers look forward and adjust price expectations and capital stocks to account for future climate effects. The potential economic gains from complying with the Paris Accord are also estimated, showing that even with a limited set of possible damages from global warming, these gains are substantial. For example, with the comparative case of Representative Concentration Pathway 8.5 (4°C), the global gains from complying with the 2°C target (Representative Concentration Pathway 4.5) are approximately US$17,489 billion per year in the long run (year 2100). The relative damages from not complying to Sub-Sahara Africa, India, and Southeast Asia, across all temperature ranges, are especially severe.
In 2005, all WHO Member States pledged to fight for universal health coverage (UHC). The availability of financial, human and technological resources seems to be necessary to develop efficient health policies and also to offer UHC. One of the main challenges facing the health sector comes from the need to innovate efficiently. The intense use of information and communication technologies (ICTs) in the health field evidences a notable improvement in results obtained by institutions, health professionals and patients, principally in developed countries. In the Americas, the relationship between economic development and health innovation is not particularly evident. Data from 19 of 35 countries surveyed in the 2015 Third Global Survey on eHealth for the region of the Americas were analysed. 52.6% of the countries of the Americas have a national policy or strategy for UHC. 57.9% of the countries in the sample indicate that they have a national eHealth policy or strategy, but only 26.3% have an entity that supervises the quality, safety and reliability regulations for mobile health applications. The survey data indicate that high-income and low-income to middle-income countries show higher percentages in relation to the existence of entities that promote innovation. These countries also exceed 60%—compared with 40% and 50% in lower-income countries—in all cases regarding the use of eHealth practices, such as mobile health, remote patient monitoring or telehealth. 100% of low-income countries report offering ICT training to healthcare professionals, compared with 83% of wealthy countries and 81% of middle-income to high-income countries.
Active travel (walking and cycling) is beneficial for people’s health and has many co-benefits, such as reducing motor vehicle congestion and pollution in urban areas. There have been few robust evaluations of active travel, and very few studies have valued health and emissions outcomes. The ACTIVE before-and-after quasi-experimental study estimated the net benefits of health and other outcomes from New Zealand’s Model Communities Programme using an empirical analysis comparing two intervention cities with two control cities. The Programme funded investment in cycle paths, other walking and cycling facilities, cycle parking, ‘shared spaces’, media campaigns and events, such as ‘Share the Road’, and cycle-skills training. Using the modified Integrated Transport and Health Impacts Model, the Programme’s net economic benefits were estimated from the changes in use of active travel modes. Annual benefits for health in the intervention cities were estimated at 34.4 disability-adjusted life years (DALYs) and two lives saved due to reductions in cardiac disease, diabetes, cancer, and respiratory disease. Reductions in transport-related carbon emissions were also estimated and valued. Using a discount rate of 3.5%, the estimated benefit/cost ratio was 11:1 and was robust to sensitivity testing. It is concluded that when concerted investment is made in active travel in a city, there is likely to be a measurable, positive return on investment.
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 anthropogenic climate change threatens to undermine the past 50 years of gains in public health, and conversely, that a comprehensive response to climate change could be “the greatest global
health opportunity of the 21st century”. The Lancet Countdown is a collaboration between 24 academic institutions and intergovernmental organisations based in every continent and with representation from a wide range of disciplines. The collaboration includes climate scientists, ecologists, economists, engineers, experts in energy, food, and transport systems, geographers, mathematicians, social and political scientists, public health professionals, and doctors. It reports annual indicators across five sections: climate change impacts, exposures, and vulnerability; adaptation planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. The key messages from the 40 indicators in the Lancet Countdown’s 2017 report are summarised below.
There is growing recognition that implementation of low-carbon policies in urban passenger transport has near-term health co-benefits through increased physical activity and improved air quality. Nevertheless, co-benefits and related cost reductions are often not taken into account in decision processes, likely because they are not easy to capture. In an interdisciplinary multi-model approach we address this gap, investigating the co-benefits resulting from increased physical activity and improved air quality due to climate mitigation policies for three urban areas. Additionally we take a (macro-)economic perspective, since that is the ultimate interest of policy-makers. Methodologically, we link a transport modelling tool, a transport emission model, an emission dispersion model, a health model and a macroeconomic Computable General Equilibrium (CGE) model to analyze three climate change mitigation scenarios. We show that higher levels of physical exercise and reduced exposure to pollutants due to mitigation measures substantially decrease morbidity and mortality. Expenditures are mainly born by the public sector but are mostly offset by the emerging co-benefits. Our macroeconomic results indicate a strong positive welfare effect, yet with slightly negative GDP and employment effects. We conclude that considering economic co-benefits of climate change mitigation policies in urban mobility can be put forward as a forceful argument for policy makers to take action.
It is increasingly necessary to quantify the impacts of climate change on populations, and to quantify the effectiveness of mitigation and adaptation strategies. Despite growing interest in the health effects of climate change, the relationship between mental health and climate change has received little attention in research or policy. Here, we outline current thinking about climate change and mental health, and discuss crucial limitations in modern epidemiology for examining this issue. A systems approach, complemented by a new style of research thinking and leadership, can help align the needs of this emerging field with existing and research policy agendas.
Background: Although the co-benefits from addressing problems related to both climate change and air pollution have been recognised, there is not much evidence comparing the mitigation costs and economic benefits of air pollution reduction for alternative approaches to meeting greenhouse gas targets. We analysed the extent to which health co-benefits would compensate the mitigation cost of achieving the targets of the Paris climate agreement (2°C and 1·5°C) under different scenarios in which the emissions abatement effort is shared between countries in accordance with three established equity criteria.
Methods: Our study had three stages. First, we used an integrated assessment model, the Global Change Assessment Model (GCAM), to investigate the emission (greenhouse gases and air pollutants) pathways and abatement costs of a set of scenarios with varying temperature objectives (nationally determined contributions, 2°C, or 1·5°C) and approaches to the distribution of climate change methods (capability, constant emission ratios, and equal per capita). The resulting emissions pathways were transferred to an air quality model (TM5-FASST) to estimate the concentrations of particulate matter and ozone in the atmosphere and the resulting associated premature deaths and morbidity. We then applied a monetary value to these health impacts by use of a term called the value of statistical life and compared these values with those of the mitigation costs calculated from GCAM, both globally and regionally. Our analysis looked forward to 2050 in accordance with the socioeconomic narrative Shared Socioeconomic Pathways 2.
Findings: The health co-benefits substantially outweighed the policy cost of achieving the target for all of the scenarios that we analysed. In some of the mitigation strategies, the median co-benefits were double the median costs at a global level. The ratio of health co-benefit to mitigation cost ranged from 1·4 to 2·45, depending on the scenario. At the regional level, the costs of reducing greenhouse gas emissions could be compensated with the health co-benefits alone for China and India, whereas the proportion the co-benefits covered varied but could be substantial in the European Union (7–84%) and USA (10–41%), respectively. Finally, we found that the extra effort of trying to pursue the 1·5°C target instead of the 2°C target would generate a substantial net benefit in India (US$3·28–8·4 trillion) and China ($0·27–2·31 trillion), although this positive result was not seen in the other regions.
Interpretation: Substantial health gains can be achieved from taking action to prevent climate change, independent of any future reductions in damages due to climate change. Some countries, such as China and India, could justify stringent mitigation efforts just by including health co-benefits in the analysis. Our results also suggest that the statement in the Paris Agreement to pursue efforts to limit temperature increase to 1·5°C could make economic sense in some scenarios and countries if health co-benefits are taken into account.
Funding: European Union's Horizon 2020 research and innovation programme.
Background
Carbon footprints stemming from health care have been found to be variable, from 3% of the total national CO2 equivalent (CO2e) emissions in England to 10% of the national CO2e emissions in the USA. We aimed to measure the carbon footprint of Australia's health-care system.
Methods
We did an observational economic input–output lifecycle assessment of Australia's health-care system. All expenditure data were obtained from the 15 sectors of the Australian Institute of Health and Welfare for the financial year 2014–15. The Australian Industrial Ecology Virtual Laboratory (IELab) data were used to obtain CO2e emissions per AUS$ spent on health care.
Findings
In 2014–15 Australia spent $161·6 billion on health care that led to CO2e emissions of about 35 772 (68% CI 25 398–46 146) kilotonnes. Australia's total CO2e emissions in 2014–15 were 494 930 kilotonnes, thus health care represented 35 772 (7%) of 494 930 kilotonnes total CO2e emissions in Australia. The five most important sectors within health care in decreasing order of total CO2e emissions were: public hospitals (12 295 [34%] of 35 772 kilotonnes CO2e), private hospitals (3635 kilotonnes [10%]), other medications (3347 kilotonnes [9%]), benefit-paid drugs (3257 kilotonnes [9%]), and capital expenditure for buildings (2776 kilotonnes [8%]).
Interpretation
The carbon footprint attributed to health care was 7% of Australia's total; with hospitals and pharmaceuticals the major contributors. We quantified Australian carbon footprint attributed to health care and identified health-care sectors that could be ameliorated. Our results suggest the need for carbon-efficient procedures, including greater public health measures, to lower the impact of health-care services on the environment.
Funding
None.
It is widely acknowledged that the climate is warming globally and within the UK. In this paper, studies which assess the direct impact of current increased temperatures and heat-waves on health and those which project future health impacts of heat under different climate change scenarios in the UK are reviewed.
This review finds that all UK studies demonstrate an increase in heat-related mortality occurring at temperatures above threshold values, with respiratory deaths being more sensitive to heat than deaths from cardiovascular disease (although the burden from cardiovascular deaths is greater in absolute terms). The relationship between heat and other health outcomes such as hospital admissions, myocardial infarctions and birth outcomes is less consistent. We highlight the main populations who are vulnerable to heat. Within the UK, these are older populations, those with certain co-morbidities and those living in Greater London, the South East and Eastern regions.
In all assessments of heat-related impacts using different climate change scenarios, deaths are expected to increase due to hotter temperatures, with some studies demonstrating that an increase in the elderly population will also amplify burdens. However, key gaps in knowledge are found in relation to how urbanisation and population adaptation to heat will affect health impacts, and in relation to current and future strategies for effective, sustainable and equitable adaptation to heat. These and other key gaps in knowledge, both in terms of research needs and knowledge required to make sound public- health policy, are discussed.
Electronic supplementary material
The online version of this article (10.1186/s12940-017-0322-5) contains supplementary material, which is available to authorized users.
Vibrio parahaemolyticus is the leading cause of seafood-related infections with illnesses undergoing a geographic expansion. In this process of expansion, the most fundamental change has been the transition from infections caused by local strains to the surge of pandemic clonal types. Pandemic clone sequence type 3 (ST3) was the only example of transcontinental spreading until 2012, when ST36 was detected outside the region where it is endemic in the U.S. Pacific Northwest causing infections along the U.S. northeast coast and Spain. Here, we used genome-wide analyses to reconstruct the evolutionary history of the V. parahaemolyticus ST36 clone over the course of its geographic expansion during the previous 25 years. The origin of this lineage was estimated to be in ~1985. By 1995, a new variant emerged in the region and quickly replaced the old clone, which has not been detected since 2000. The new Pacific Northwest (PNW) lineage was responsible for the first cases associated with this clone outside the Pacific Northwest region. After several introductions into the northeast coast, the new PNW clone differentiated into a highly dynamic group that continues to cause illness on the northeast coast of the United States. Surprisingly, the strains detected in Europe in 2012 diverged from this ancestral group around 2000 and have conserved genetic features present only in the old PNW lineage. Recombination was identified as the major driver of diversification, with some preliminary observations suggesting a trend toward a more specialized lifestyle, which may represent a critical element in the expansion of epidemics under scenarios of coastal warming.
We propose a simple real-time index of global human-induced warming and assess its robustness to uncertainties in climate forcing and short-term climate fluctuations. This index provides improved scientific context for temperature stabilisation targets and has the potential to decrease the volatility of climate policy. We quantify uncertainties arising from temperature observations, climate radiative forcings, internal variability and the model response. Our index and the associated rate of human-induced warming is compatible with a range of other more sophisticated methods to estimate the human contribution to observed global temperature change.
Significance
Agricultural production is vulnerable to climate change. Understanding climate change, especially the temperature impacts, is critical if policymakers, agriculturalists, and crop breeders are to ensure global food security. Our study, by compiling extensive published results from four analytical methods, shows that independent methods consistently estimated negative temperature impacts on yields of four major crops at the global scale, generally underpinned by similar impacts at country and site scales. Multimethod analyses improved the confidence in assessments of future climate impacts on global major crops, with important implications for developing crop- and region-specific adaptation strategies to ensure future food supply of an increasing world population.
Vibrio parahaemolyticus is recognized as major cause of foodborne illness of global public health concern. This study collected 107 strains of V. parahaemolyticus during active surveillance of diarrheal diseases in hospitals in Zhoushan during 2013 to 2014 and investigated their serotypes, virulence genes (tdh, trh, and orf8), antimicrobial resistance, and genotypes. The dominant serotypes of the 107 clinical strains were O3:K6, O4:K8, and O4: KUT with 87.9% and 3.7% of the strains carrying the virulence genes tdh and trh, respectively. Molecular typing by pulsed-field gel electrophoresis indicated divergence among the clinical strains. Most isolates were sensitive to the common antimicrobial agents used against the Vibrio species except ampicillin. We conclude that continuous surveillance of V. parahaemolyticus in diarrhea patients is a public health priority and is useful for conducting risk assessment of foodborne illnesses caused by V. parahaemolyticus. © 2017 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Every year at the United Nations (UN), member states deliver statements during the General Debate (GD) discussing major issues in world politics. These speeches provide invaluable information on governments’ perspectives and preferences on a wide range of issues, but have largely been overlooked in the study of international politics. This paper introduces a new dataset consisting of over 7300 country statements from 1970–2014. We demonstrate how the UN GD corpus (UNGDC) can be used as a resource from which country positions on different policy dimensions can be derived using text analytic methods. The article provides applications of these estimates, demonstrating the contribution the UNGDC can make to the study of international politics.
Consequences of shifting species distributions
Climate change is causing geographical redistribution of plant and animal species globally. These distributional shifts are leading to new ecosystems and ecological communities, changes that will affect human society. Pecl et al. review these current and future impacts and assess their implications for sustainable development goals.
Science , this issue p. eaai9214
Climate change is causing increases in temperature, changes in precipitation and extreme weather events, sea-level rise, and other environmental impacts. It is also causing or contributing to heat-related disorders, respiratory and allergic disorders, infectious diseases, malnutrition due to food insecurity, and mental health disorders. In addition, increasing evidence indicates that climate change is causally associated with collective violence, generally in combination with other causal factors. Increased temperatures and extremes of precipitation with their associated consequences, including resultant scarcity of cropland and other key environmental resources, are major pathways by which climate change leads to collective violence. Public health professionals can help prevent collective violence due to climate change (a) by supporting mitigation measures to reduce greenhouse gas emissions, (b) by promoting adaptation measures to address the consequences of climate change and to improve community resilience, and (c) by addressing underlying risk factors for collective violence, such as poverty and socioeconomic disparities. Expected final online publication date for the Annual Review of Public Health Volume 38 is March 20, 2017. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Cycling mobility has often been neglected in transport planning. Nevertheless, the potential benefits of increasing the bicycle share make cycling promotion a key element for transforming cities toward sustainability. This research addresses the case study of Vitoria-Gasteiz, a city where the bicycle share has almost quadrupled in eight years. Through an exploratory analysis of the city's last mobility surveys we find some insights into the bicycle user profile and the cycling trip. The results show differences between cyclist and non-cyclist groups especially by gender and age. On this account, target groups for addressing probike transport policies can be better identified.
The Lancet Countdown: tracking progress on health and climate change is an international, multidisciplinary research collaboration between academic institutions and practitioners across the world. It follows on from the work of the 2015 Lancet Commission, which concluded that the response to climate change could be “the greatest global health opportunity of the 21st century”. The Lancet Countdown aims to track the health impacts of climate hazards; health resilience and adaptation; health co-benefits of climate change mitigation; economics and finance; and political and broader engagement. These focus areas form the five thematic working groups of the Lancet Countdown and represent different aspects of the complex association between health and climate change. These thematic groups will provide indicators for a global overview of health and climate change; national case studies highlighting countries leading the way or going against the trend; and engagement with a range of stakeholders. The Lancet Countdown ultimately aims to report annually on a series of indicators across these five working groups. This paper outlines the potential indicators and indicator domains to be tracked by the collaboration, with suggestions on the methodologies and datasets available to achieve this end. The proposed indicator domains require further refinement, and mark the beginning of an ongoing consultation process—from November, 2016 to early 2017—to develop these domains, identify key areas not currently covered, and change indicators where necessary. This collaboration will actively seek to engage with existing monitoring processes, such as the UN Sustainable Development Goals and WHO's climate and health country profiles. The indicators will also evolve over time through ongoing collaboration with experts and a range of stakeholders, and be dependent on the emergence of new evidence and knowledge. During the course of its work, the Lancet Countdown will adopt a collaborative and iterative process, which aims to complement existing initiatives, welcome engagement with new partners, and be open to developing new research projects on health and climate change.
This study uses the GAINS model framework to estimate current and future emissions of fluorinated greenhouse gases (F-gases), their abatement potentials, and costs for twenty source sectors and 162 countries and regions, which are aggregated to produce global estimates. Global F-gas (HFCs, PFCs, and SF6) emissions are estimated at 0.7 Pg CO2 eq. in 2005 with an expected increase to 3.7 Pg CO2 eq. in 2050 if application of control technology remains at the current level. There are extensive opportunities to reduce emissions using existing technology and alternative substances with low global warming potential. Estimates show that it would be technically feasible to reduce cumulative F-gas emissions from 81 to 11 Pg CO2 eq. between 2018 and 2050. A reduction in cumulative emissions to 23 Pg CO2 eq. is estimated to be possible at a marginal abatement cost below 10 EUR t−1 CO2 eq. We also find that future F-gas abatement is expected to become relatively more costly for developing than developed countries due to differences in the sector contribution to emissions and abatement potentials.