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

Cause of death variation under the shared socioeconomic pathways

Climate change will create numerous risks for human health, including impacts associated with temperature extremes, diarrheal diseases, and undernutrition. Such risks, along with other socioeconomic and development trends, will affect cause-of-death patterns experienced in the coming decades. This study explores future mortality trends using the shared socioeconomic pathways (SSP) framework, a widely utilized tool for understanding socioeconomic development trends in a world with climate change. Existing projections for GDP, urbanization, and demographic trends based on SSP narratives are incorporated into an integrated assessment model, International Futures (IFs), in order to project mortality levels by cause of death for all countries from 2020 to 2100. Under more optimistic SSPs, non-communicable diseases (NCDs) rise as a proportion of all deaths, particularly in low- and middle-income countries, while more pessimistic SSPs suggest a continued high burden of largely preventable communicable diseases. In high-income countries, significant continued burdens of NCDs are projected for the remainder of the century under all SSPs. Comparisons are also made to recent cause-of-death projections from the Institute for Health Metrics and Evaluation (IHME) to assess how the IFs and IHME models vary.

Quantification of the Effects of Droughts on Daily Mortality in Spain at Different Timescales at Regional and National Levels: A Meta-Analysis

A performance assessment of two different indices (the Standardized Precipitation Index (SPI) and the Standardized Precipitation Evapotranspiration Index (SPEI)) for monitoring short-term and short–medium-term drought impacts on daily specific-cause mortality in Spain was conducted. To achieve a comprehensive, nationwide view, a meta-analysis was performed using a combination of provincial relative risks (RRs). Moreover, the subdivisions of Spain based on administrative, climatic, and demographic criteria to obtain the measures of combined risks were also taken into account. The results of the SPEI and SPI calculated at the same timescale were similar. Both showed that longer drought events produced greater RR values, for respiratory mortality. However, at the local administrative level, Galicia, Castilla-y-Leon, and Extremadura showed the greatest risk of daily mortality associated with drought episodes, with Andalucía, País Vasco, and other communities being notably impacted. Based on climatic regionalization, Northwest, Central, and Southern Spain were the regions most affected by different drought conditions for all analyzed causes of daily mortality, while the Mediterranean coastal region was less affected. Demographically, the regions with the highest proportion of people aged 65 years of age and over reflected the greatest risk of daily natural, circulatory, and respiratory mortality associated with drought episodes.

A comparative life cycle assessment of centralised and decentralised wood pellets production for residential heating

Recently, wood pellets have become a reliable and clean renewable fuel for residential heating, replacing fossil fuels and reducing greenhouse gas emissions. Wood pellets are normally produced in industrial pellet plants (centralised production), but decentralised small-scale local production also occurs. This study applies Life Cycle Assessment (LCA) to quantify and compare the environmental profile of one centralised and two decentralised alternatives for wood pellet production for residential heating in Portugal: (1) industrial wood pellets production (centralised), (2) wood pellets production at sawmills (decentralised) and (3) wood pellets production at households (decentralised). System boundaries include the stages of forest management, wood pellet production, wood pellet distribution and wood pellet energetic conversion. The impact results show that industrial pellet production ranks as the worst alternative, while pellet production at households has the best environmental profile for all the impact categories under study. However, the environmental impacts of pellet production at the sawmill do not differ greatly from those of the pellet production at households; they are 14 to 16% higher for global warming and fossil resources scarcity and 0.3 to 3% higher for the remaining impact categories. The worst environmental performance of the industrial pellet production alternative is mainly due to high electricity and diesel consumption during wood pellet production and the use of logging residues to generate heat for drying biomass feedstock. A sensitivity analysis was performed to evaluate the influence of changing the distance travelled during the transport of packed pellets to stores and sawdust to households. The results show changes in the environmental performance ranking, highlighting that for short distances, both decentralised alternatives can be more sustainable from an environmental perspective than the centralised alternative, but for larger distances, the pellet production at households should be avoided.

Premature Deaths in Brazil Associated With Long-Term Exposure to PM2.5 From Amazon Fires Between 2016 and 2019

Amazonian deforestation from slash-and-burn practices is a significant contributor to biomass burning within Brazil. Fires emit carbonaceous aerosols that negatively impact human health by increasing fine particulate matter (PM2.5) exposure. These negative effects on health compound the already detrimental climatological and ecological impacts. Despite high biomass burning emissions in Brazil and the international attention drawn by the relaxation of Amazon protections in 2019, little is known about the health impacts from PM2.5 exposure attributable to these fires. We estimate PM2.5-related premature deaths in Brazil associated with biomass burning, focusing on temporal, interannual, and spatial trends. We find that during the fire season of 2019, 4,966 (2,427, 8,340) premature deaths were attributable to fire emissions making up 10% (5, 17) of all PM2.5-related premature deaths in Brazil. Between the 2019 and 2018 seasons, fire emissions increased by 1.37 Tg (1.00, 2.18) or 115% (60, 201), which was responsible for an increase in health impacts of 2,109 (965, 3,623) premature deaths or 74% (54, 98). Biomass burning emissions throughout Brazil contribute significantly to premature deaths, with the largest burning events occurring in northwestern Brazil. The impact of fires on PM2.5-related premature deaths is highest in heavily populated regions despite their fires being 1 to 2 orders of magnitude smaller than the largest burning events. Results from this study characterize the extent to which elevated PM2.5 exposure levels owing to fires affect public health in Brazil and present an additional, public health-focused, support for increased Amazon protections.

Climate anxiety: Psychological responses to climate change

Climate change will affect psychological wellbeing. Substantial research has documented harmful impacts on physical health, mental health, and social relations from exposure to extreme weather events that are associated with climate change. Recently, attention has turned to the possible effects of climate change on mental health through emotional responses such as increased anxiety. This paper discusses the nature of climate anxiety and some evidence for its existence, and speculates about ways to address it. Although climate anxiety appears to be a real phenomenon that deserves clinical attention, it is important to distinguish between adaptive and maladaptive levels of anxiety. A focus on individual mental health should not distract attention from the societal response that is necessary to address climate change.

Climate change and pediatric skin health

Children are known to disproportionately bear the health impacts of climate change, particularly children living in impoverished areas. Owing to their developing physiology and immature metabolism, distinct exposure behaviors, and reliance on adults for care and protection, children are uniquely susceptible to the adverse effects of our warming planet. Herein, we summarize the known impacts of climate change on pediatric skin health, including its effects on atopic dermatitis, vector-borne and other infectious diseases, nutritional deficiencies, and psychodermatoses.

Climate Change and Childhood Respiratory Health: A Call to Action for Paediatricians

Climate change (CC) is one of the main contributors to health emergencies worldwide. CC appears to be closely interrelated with air pollution, as some pollutants like carbon dioxide (CO2), nitrogen oxides (NOx) and black carbon are naturally occurring greenhouse gases. Air pollution may enhance the allergenicity of some plants and, also, has an adverse effect on respiratory health. Children are a uniquely vulnerable group that suffers disproportionately from CC burden. The increasing global warming related to CC has a big impact on plants' lifecycles, with earlier and longer pollen seasons, as well as higher pollen production, putting children affected by asthma and allergic rhinitis at risk for exacerbations. Extreme weather events may play a role too, not only in the exacerbations of allergic respiratory diseases but, also, in favouring respiratory infections. Even though paediatricians are already seeing the impacts of CC on their patients, their knowledge about CC-related health outcomes with specific regards to children's respiratory health is incomplete. This advocates for paediatricians' increased awareness and a better understanding of the CC impact on children's respiratory health. Having a special responsibility for children, paediatricians should actively be involved in policies aimed to protect the next generation from CC-related adverse health effects. Hence, there is an urgent need for them to take action and successfully educate families about CC issues. This paper aims at reviewing the evidence of CC-related environmental factors such as temperature, humidity, rainfall and extreme events on respiratory allergic diseases and respiratory infections in children and proposing specific actionable items for paediatricians to deal with CC-related health issues in their clinical practice.

The effects of climate change on infectious diseases with cutaneous manifestations

Background

Anthropogenic climate change affects the burden of infectious diseases via several interconnected mechanisms. In recent years, there has been greater awareness of the ways in which climate-sensitive infectious diseases pose a growing threat to global public health.

Objective

This study aimed to categorize and describe the effects of climate change on infectious diseases with skin manifestations.

Methods

A scoping review of the MEDLINE and PubMed online databases for climate-sensitive infections was performed in February and March 2020. A representative selection of conditions with skin manifestations was included in this review.

Results

Several representative climate-sensitive infectious diseases were identified in each of the following categories: vector-borne infectious diseases, infectious diseases associated with extreme weather events, and infectious diseases linked to human migration.

Conclusion

Climate variables directly influence the survival and reproduction of infectious microorganisms, their vectors, and their animal reservoirs. Due to sustained warmer temperatures at higher latitudes, climate change has expanded the geographic range of certain pathogenic microbes. More frequent climate change-related extreme weather events create circumstances where existing infectious microorganisms flourish and novel infections emerge. Climate instability is linked to increased human migration, which disrupts health care infrastructure as well as the habitats of microbes, vectors, and animal reservoirs and leads to widespread poverty and overcrowding. Dermatologists should understand that climate change will affect the burden and geographic distribution of infectious diseases, many of which have cutaneous signs and might be encountered in their regular practice.

The lady with the lamp: Amid the COVID-19 haze

The COVID-19 pandemic is currently the dominant public health topic across every nation. The world of health care is shrouded in the haze of the COVID-19 pandemic and is experiencing unprecedented patient loads arising from this complicated and unfamiliar viral disease. No one was prepared for this. Unsurprisingly, there are shortages of supplies and equipment, treatment space and people with the skills to respond to the containment, treatment and prevention of COVID-19. Nurses are at the front line of every nation's response, trying to provide assessment, protection, treatment and prevention as being part of the overwhelming care demand that is occurring. Across every nation, the ongoing policy implications of the pandemic should be considered, as well as for those pandemics in the future. This includes, but is not limited to, investing in emergency systems and nurses, health research, and preparing for, managing and researching nursing practice.

Impact of the SARS-CoV-2 on the Italian Agri-Food Sector: An Analysis of the Quarter of Pandemic Lockdown and Clues for a Socio-Economic and Territorial Restart

The recent outbreak of a new Coronavirus has developed into a global pandemic with about 10.5 million reported cases and over 500,000 deaths worldwide. Our prospective paper reports an updated analysis of the impact that this pandemic had on the Italian agri-food sector during the national lockdown and discusses why and how this unprecedented economic crisis could be a turning point to deal with the overall sustainability of food and agricultural systems in the frame of the forthcoming European Green Deal. Its introductory part includes a wide-ranging examination of the first quarter of pandemic emergency, with a specific focus on the primary production, to be understood as agriculture (i.e., crops and livestock, and their food products), fisheries, and forestry. The effect on the typical food and wine exports, and the local environment tourism segments is also taken into account in this analysis, because of their old and deep roots into the cultural and historical heritage of the country. The subsequent part of the paper is centered on strategic lines and research networks for an efficient socio-economic and territorial restart, and a faster transition to sustainability in the frame of a circular bio-economy. Particular emphasis is given to the urgent need of investments in research and development concerning agriculture, in terms of not only a fruitful penetration of the agro-tech for a next-generation agri-food era, but also a deeper attention to the natural and environmental resources, including forestry. As for the rest of Europe, Italy demands actions to expand knowledge and strengthen research applied to technology transfer for innovation activities aimed at providing solutions for a climate neutral and resilient society, in reference to primary production to ensure food security and nutrition quality. Our expectation is that science and culture return to play a central role in national society, as their main actors are capable of making a pivotal contribution to renew and restart the whole primary sector and agri-food industry, addressing also social and environmental issues, and so accelerating the transition to sustainability.

Climate change glossary for public health practice: from vulnerability to climate justice

Climate change is an emerging and growing field of practice for the international public health community. As practitioners, researchers and policy-makers grapple with the local health impacts of climate change, there is an increasing need to clarify key terminology to support public health actors engage and respond in ways that promote intersectoral collaboration. This contribution introduces the public health discourse on climate change, with a particular focus on its implications for health equity. After defining key terms and existing adaptation practices, climate justice and assets-oriented inquiry into the intersectional determinants of health are discussed as future opportunities for addressing health equity in climate and health-related research and practice.

The environmental footprint of health care: a global assessment

BACKGROUND

Health-care services are necessary for sustaining and improving human wellbeing, yet they have an environmental footprint that contributes to environment-related threats to human health. Previous studies have quantified the carbon emissions resulting from health care at a global level. We aimed to provide a global assessment of the wide-ranging environmental impacts of this sector.

METHODS

In this multiregional input-output analysis, we evaluated the contribution of health-care sectors in driving environmental damage that in turn puts human health at risk. Using a global supply-chain database containing detailed information on health-care sectors, we quantified the direct and indirect supply-chain environmental damage driven by the demand for health care. We focused on seven environmental stressors with known adverse feedback cycles: greenhouse gas emissions, particulate matter, air pollutants (nitrogen oxides and sulphur dioxide), malaria risk, reactive nitrogen in water, and scarce water use.

FINDINGS

Health care causes global environmental impacts that, depending on which indicator is considered, range between 1% and 5% of total global impacts, and are more than 5% for some national impacts.

INTERPRETATION

Enhancing health-care expenditure to mitigate negative health effects of environmental damage is often promoted by health-care practitioners. However, global supply chains that feed into the enhanced activity of health-care sectors in turn initiate adverse feedback cycles by increasing the environmental impact of health care, thus counteracting the mission of health care.

FUNDING

Australian Research Council, National eResearch Collaboration Tools and Resources project.

A GeoHealth Response to a Geoscience Community Climate Change Position Statement

The American Geophysical Union (AGU) issues position statements reflecting the state of the science and scientific consensus. AGU position statements can be used to support public and institutional policy development, conversations with peers and policymakers, and formal and informal education. The recent climate change position statement, "Society Must Address the Growing Climate Crisis now," provides important baseline information but lacks detail on critical climate and health impacts and actions for AGU and members. This commentary shares feedback from the AGU's GeoHealth Section and encourages members to use the AGU statement and engage in the comment process for other statements.

Early Warnings: The Lessons of COVID-19 for Public Health Climate Preparedness

The early 2020 response to COVID-19 revealed major gaps in public health systems around the world as many were overwhelmed by a quickly-spreading new coronavirus. While the critical task at hand is turning the tide on COVID-19, this pandemic serves as a clarion call to governments and citizens alike to ensure public health systems are better prepared to meet the emergencies of the future, many of which will be climate-related. Learning from the successes as well as the failures of the pandemic response provides some guidance. We apply several recommendations of a recent World Health Organization Policy Brief on COVID-19 response to 5 key areas of public health systems - governance, information, services, determinants, and capacity - to suggest early lessons from the coronavirus pandemic for climate change preparedness. COVID-19 has demonstrated how essential public health is to well-functioning human societies and how high the economic cost of an unprepared health system can be. This pandemic provides valuable early warnings, with lessons for building public health resilience.

Population health, economics and ethics in the age of COVID-19

Are the steps that have been taken to arrest the spread of COVID-19 justifiable? Specifically, are they likely to have improved public health understood according to widely used aggregate population health measures, such as Quality Adjusted Life Years (QALYs) and Disability Adjusted Life Years (DALYs) as much or more than alternatives? This is a reasonable question, since such measures have been promoted extensively in global and national health policy by influential actors, and they have become almost synonymous with quantification of public health. If the steps taken against COVID-19 did not meet this test, then either the measures or the policies must be re-evaluated. There are indications that policies against COVID-19 may have been unbalanced and therefore not optimal. A balanced approach to protecting population health should be proportionate in its effects across distinct health concerns at a moment, across populations over time and across populations over space. These criteria provide a guide to designing and implementing policies that diminish harm from COVID-19 while also providing due attention to other threats to aggregate population health. They should shape future policies in response to this pandemic and others.

Conservation of Xylose Fermentability in Phlebia Species and Direct Fermentation of Xylan by Selected Fungi

In efforts to lower the cost of total conversion of lignocellulosic materials, utilization of hemicellulose must be considered. White-rot fungus Phlebia sp. MG-60 can produce ethanol directly from cellulose and has fermentation ability for glucose, cellulose, and xylose. Therefore, white-rot fungi can be considered a good candidate for consolidated bioprocessing to give bioethanol from lignocellulosic biomass, although little information is available on the direct fermentation of xylan. In the present study, some Phlebia species were selected as candidates because of their ability to ferment xylose to ethanol more efficiently than Phlebia sp. MG-60. This process indicated that the basidiomycetes that can produce ethanol from xylose are closely related genetically within the Phlebia genus. The selected Phlebia species showed higher ethanol productivity from corn core and beechwood xylans than Phlebia sp. MG-60. The ethanol yields from corn core xylan in culture with Phlebia acerina HHB11146, Phlebia ludoviciana HHB9640, and Phlebia subochracea HHB8494 were 46.2%, 46.7%, and 39.7% of theoretical maximum, and those from beechwood xylan were 19.09%, 17.7%, and 21.4% of the theoretical maximum, respectively.

Using Satellites to Track Indicators of Global Air Pollution and Climate Change Impacts: Lessons Learned From a NASA-Supported Science-Stakeholder Collaborative

The 2018 NASA Health and Air Quality Applied Science Team (HAQAST) "Indicators" Tiger Team collaboration between NASA-supported scientists and civil society stakeholders aimed to develop satellite-derived global air pollution and climate indicators. This Commentary shares our experience and lessons learned. Together, the team developed methods to track wildfires, dust storms, pollen counts, urban green space, nitrogen dioxide concentrations and asthma burdens, tropospheric ozone concentrations, and urban particulate matter mortality. Participatory knowledge production can lead to more actionable information but requires time, flexibility, and continuous engagement. Ground measurements are still needed for ground truthing, and sustained collaboration over time remains a challenge.

'Calibrating to scale: a framework for humanitarian health organizations to anticipate, prevent, prepare for and manage climate-related health risks'

Climate Change is adversely affecting health by increasing human vulnerability and exposure to climate-related stresses. Climate change impacts human health both directly and indirectly, through extreme weather events, changing distribution of health risks, increased risks of undernutrition, population displacement, and greater risks of injuries, disease, and death (Ebi, K., Campbell-Lendrum, D., & Wyns, A. The 1. 5 health report. WHO. 2018). This risk amplification is likely to increase the need for humanitarian support. Recent projections indicate that under a business as usual scenario of sustained greenhouse gas emissions, climate change could double the demand for humanitarian assistance by 2050 (World Health Organization. Operational Framework for building climateresilient health systems. WHO. 2015). Humanitarian assistance is currently not meeting the existing needs, therefore, any additional burden is likely to be highly challenging.Global health advocates, researchers, and policymakers are calling for urgent action on climate change, yet there is little clarity on what that action practically entails for humanitarian organizations. While some humanitarian organizations may consider themselves well designed to respond, climate change as a transversal threat requires the incorporation of a resilience approach to humanitarian action and policy responses.By bringing together authors from two historically disparate fields - climate change and health, and humanitarian assistance - this paper aims to increase the capacity of humanitarian organizations to protect health in an unstable climate by presenting an adapted framework. We adapted the WHO operational framework for climate-resilient health systems for humanitarian organizations and present concrete case studies to demonstrate how the framework can be implemented. Rather than suggest a re-design of humanitarian operations we recommend the application of a climate-lens to humanitarian activities, or what is also referred to as mainstreaming climate and health concerns into policies and programs. The framework serves as a starting point to encourage further dialogue, and to strengthen collaboration within, between, and beyond humanitarian organizations.

Projections of Ambient Temperature- and Air Pollution-Related Mortality Burden Under Combined Climate Change and Population Aging Scenarios: a Review

PURPOSE OF REVIEW

Climate change will affect mortality associated with both ambient temperature and air pollution. Because older adults have elevated vulnerability to both non-optimal ambient temperature (heat and cold) and air pollution, population aging can amplify future population vulnerability to these stressors through increasing the number of vulnerable older adults. We aimed to review recent evidence on projections of temperature- or air pollution-related mortality burden (i.e., number of deaths) under combined climate change and population aging scenarios, with a focus on evaluating the role of population aging in assessing these health impacts of climate change. We included studies published between 2014 and 2019 with age-specific population projections.

RECENT FINDINGS

We reviewed 16 temperature projection studies and 15 air pollution projection studies. Nine of the temperature studies and four of the air pollution studies took population aging into account by performing age-stratified analyses that utilized age-specific relationships between temperature or air pollution exposures and mortality (i.e., age-specific exposure-response functions (ERFs)). Population aging amplifies the projected mortality burden of temperature and air pollution under a warming climate. Compared with a constant population scenario, population aging scenarios lead to less reduction or even increases in cold-related mortality burden, resulting in substantial net increases in future overall (heat and cold) temperature-related mortality burden. There is strong evidence suggesting that to accurately assess the future temperature- and air pollution-related mortality burden of climate change, investigators need to account for the amplifying effect of population aging. Thus, all future studies should incorporate age-specific population size projections and age-specific ERFs into their analyses. These studies would benefit from refinement of age-specific ERF estimates.

Comparison of cricket diet with peanut-based and milk-based diets in the recovery from protein malnutrition in mice and the impact on growth, metabolism and immune function

Some evidence suggests that edible insects could be used to treat malnutrition following protein deficiency. However, additional studies are needed to better assess the potential of edible insects as a therapeutic food supplement and their long-term impact on recovery from malnutrition. The goals of this study were to investigate the effectiveness of a cricket-based diet in recovery from protein-malnutrition in early life, and to compare cricket protein to more traditional sources used for food fortification and supplementation. Protein-malnutrition was induced by administration of an isocaloric hypoprotein diet (5% protein calories) in young male mice for two weeks during puberty, followed by a six-week recovery period using a cricket-, peanut- or milk-based diet. We examined the impact of protein-malnutrition and subsequent recovery on body weight, growth and select biomarkers of inflammation and metabolism. Protein-malnutrition resulted in growth retardation, downregulation of inflammatory markers in spleen tissue, decreased levels of serum triglycerides, and elevated serum levels of leptin and adiponectin. The cricket-based diet performed equally well as the peanut- and milk-based diets in body weight recovery, but there were differences in immune and metabolic markers among the different recovery diets. Results suggest edible crickets may provide an alternative nutrient-dense protein source with relatively low environmental demands for combating the effects of early-life malnutrition compared to more traditional supplementation and fortification sources. Additional investigations are needed to examine the short and long term impacts of different recovery diets on metabolism and immune function.

[Heath and mobility facing climate change, what are the synergies ?]

More attention is being focused on the consequences of climate change on migration and public health, but they are still poorly understood. While the health risks caused by climate change can contribute to an increase in migration, migrating and displaced people are also more exposed, due to the difficulties they face in accessing health services. The still unknown relationship between climate change, disasters, migration and health needs to be exposed.

Eating our way through the Anthropocene

This paper examines the complex interactions between food systems, diets, and the environment. We discuss the challenges facing the food system as a result of environmental degradation and climate change. We review the state of current diets and their effects on human health outcomes. As we consider paths forward, we examine holistic solutions that align nutrition, health, and environmental goals. Finally, we identify ethical questions relevant to the changing global food system. We consider our moral obligations to other people - both now and in the future - and the planet, and we posit that eating is an ethical act requiring reflection at all scales.

Impact of Extreme Weather Events on Sub-Saharan African Child and Adolescent Mental Health: A Protocol for a Systematic Review

Sub-Saharan Africa (SSA) has been identified by the Intergovernmental Panel on Climate Change (IPCC) as being the most vulnerable region to climate change impacts. A major concern is the increase in extreme weather events (EWE) such as storms, floods, droughts, heatwaves, wildfires, and landslides in SSA and their potential to affect the health and well-being of children and adolescents. The objective of this systematic review is to examine the direct and indirect impacts of EWE on the mental health of children and adolescents living in SSA, in order to inform protective adaptation strategies and promote resilience. A meta-analysis will not be possible, since the assumption is that limited studies have been published on the EWE-associated mental health impacts on children and adolescents living in SSA and that those studies that are available are heterogenous. There is acknowledgement in the global literature of the need to highlight child and adolescent mental health more prominently in climate change health strategies and policies. It is vital that adaptation strategies are informed by research on risk prevention and promotion of resilience to ensure the mental health of children and adolescents is protected.

Climate change: an enduring challenge for vector-borne disease prevention and control

Climate change is already affecting vector-borne disease transmission and spread, and its impacts are likely to worsen. In the face of ongoing climate change, we must intensify efforts to prevent and control vector-borne diseases.

Current Global Health Impact Assessment Practice

Health impact assessment (HIA) practice has expanded across the world, since it was established more than two decades ago. This paper presents a snapshot of current global HIA practice based on the findings of an online questionnaire survey. HIA practitioners from all world regions were invited to participate. A total of 122 HIA practitioners from 29 countries completed the survey, following a broad international outreach effort. The large variety in the types of HIAs conducted, and the application of HIA in various fields reported by respondents, demonstrates that HIA practice has evolved over the past two decades. Although differences in the use of HIA were reported across world regions, an overall increasing trend in global HIA practice can be observed. In order to sustain this upward trend, efforts are needed to address the main barriers in the utilisation of HIA. The establishment of new national and international HIA teaching and training offerings seems to be an obvious strategy to pursue along with the strengthening of policies and legal frameworks that specify the circumstances, under which HIA is required, and to what extent.

Climatic Changes, Water Systems, and Adaptation Challenges in Shawi Communities in the Peruvian Amazon

Climate change impacts on water systems have consequences for Indigenous communities. We documented climatic changes on water systems observed by Indigenous Shawi and resultant impacts on health and livelihoods, and explored adaptation options and challenges in partnership with two Indigenous Shawi communities in the Peruvian Amazon. Qualitative data were collected via PhotoVoice, interviews, focus group discussions, and transect walks, and analyzed using a constant comparative method and thematic analysis. Quantitative data were collected via a household survey and analyzed descriptively. Households observed seasonal weather changes over time (n = 50; 78%), which had already impacted their family and community (n = 43; 86%), such as more intense rainfall resulting in flooding (n = 29; 58%). Interviewees also described deforestation impacts on the nearby river, which were exacerbated by climate-related changes, including increased water temperatures (warmer weather, exacerbated by fewer trees for shading) and increased erosion and turbidity (increased rainfall, exacerbated by riverbank instability due to deforestation). No households reported community-level response plans for extreme weather events, and most did not expect government assistance when such events occurred. This study documents how Indigenous peoples are experiencing climatic impacts on water systems, and highlights how non-climatic drivers, such as deforestation, exacerbate climate change impacts on water systems and community livelihoods in the Peruvian Amazon.

Characteristics of Recycled Polypropylene Fibers as an Addition to Concrete Fabrication Based on Portland Cement

High-performance concrete has low tensile strength and brittle failure. In order to improve these properties of unreinforced concrete, the effects of adding recycled polypropylene fibers on the mechanical properties of concrete were investigated. The polypropylene fibers used were made from recycled plastic packaging for environmental reasons (long degradation time). The compressive, flexural and split tensile strengths after 1, 7, 14 and 28 days were tested. Moreover, the initial and final binding times were determined. This experimental work has included three different contents (0.5, 1.0 and 1.5 wt.% of cement) for two types of recycled polypropylene fibers. The addition of fibers improves the properties of concrete. The highest values of mechanical properties were obtained for concrete with 1.0% of polypropylene fibers for each type of fiber. The obtained effect of an increase in mechanical properties with the addition of recycled fibers compared to unreinforced concrete is unexpected and unparalleled for polypropylene fiber-reinforced concrete (69.7% and 39.4% increase in compressive strength for green polypropylene fiber (PPG) and white polypropylene fiber (PPW) respectively, 276.0% and 162.4% increase in flexural strength for PPG and PPW respectively, and 269.4% and 254.2% increase in split tensile strength for PPG and PPW respectively).