Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation-Lancet Commission on planetary health

The intersection of climate/environment, food, nutrition and health: crisis and opportunity

Climate/environmental change (C-E-C) is affecting human health and quality of life. Significant attention has been given to the impact of C-E-C on food supply, and food as a vehicle for exposure. However, C-E-C has been superimposed on prevalent malnutrition, infectious and non-communicable diseases. We discuss why nutrition is not synonymous with food and must be viewed as a biological variable that affects and is affected by both C-E-C as well as the current global health challenges. The nexus of C-E-C, food, nutrition and health must be considered in the development of safe and efficacious interventions. A case is presented for how the convergence of C-E-C, food/nutrition and health, presents an opportunity for more integrated approaches to achieve global health goals.

Future Earth Health Knowledge-Action Network

Future Earth is an international research platform providing the knowledge and support to accelerate our transformations to a sustainable world. Future Earth 2025 Vision identified eight key focal challenges, and challenge #6 is to "Improve human health by elucidating, and finding responses to, the complex interactions amongst environmental change, pollution, pathogens, disease vectors, ecosystem services, and people's livelihoods, nutrition and well-being." Several studies, including the Rockefeller Foundation/Lancet Planetary Health Commission Report of 2015, the World Health Organization/Convention on Biological Diversity report and those by oneHEALTH (former ecoHEALTH), have been conducted over the last 30 years. Knowledge-Action Networks (KANs) are the frameworks to apply Future Earth principles of research to related activities that respond to societal challenges. Future Earth Health Knowledge-Action Network will connect health researchers with other natural and social scientists, health and environmental policy professionals and leaders in government, the private sector and civil society to provide research-based solutions based on better, integrated understanding of the complex interactions between a changing global environment and human health. It will build regional capacity to enhance resilience, protect the environment and avert serious threats to health and will also contribute to achieving Sustainable Development Goals. In addition to the initial partners, Future Earth Health Knowledge-Action Network will further nourish collaboration with other on-going, leading research programmes outside Future Earth, by encouraging them in active participation.

How do sustainable diets fit into the climate agenda?

Food production is a major driver of greenhouse gas (GHG) emission and other environmental footprints, and dietary risk factors are contributors to non-communicable diseases. A growing body of evidence has shown that changes in what and how much we eat can offer benefits for both the environment and health. However, several data gaps and complexities remain in this research area. A better understanding and increased uptake of sustainable diets will require further research, investment, and interdisciplinary collaboration.

The Impacts of Dietary Change on Greenhouse Gas Emissions, Land Use, Water Use, and Health: A Systematic Review

Food production is a major driver of greenhouse gas (GHG) emissions, water and land use, and dietary risk factors are contributors to non-communicable diseases. Shifts in dietary patterns can therefore potentially provide benefits for both the environment and health. However, there is uncertainty about the magnitude of these impacts, and the dietary changes necessary to achieve them. We systematically review the evidence on changes in GHG emissions, land use, and water use, from shifting current dietary intakes to environmentally sustainable dietary patterns. We find 14 common sustainable dietary patterns across reviewed studies, with reductions as high as 70–80% of GHG emissions and land use, and 50% of water use (with medians of about 20–30% for these indicators across all studies) possible by adopting sustainable dietary patterns. Reductions in environmental footprints were generally proportional to the magnitude of animal-based food restriction. Dietary shifts also yielded modest benefits in all-cause mortality risk. Our review reveals that environmental and health benefits are possible by shifting current Western diets to a variety of more sustainable dietary patterns.

Social determinants and lifestyles: integrating environmental and public health perspectives

OBJECTIVE

Industrialization and urbanization have been associated with an epidemiological transition, from communicable to non-communicable disease, and a geological transition that is moving the planet beyond the stable Holocene epoch in which human societies have prospered. The lifestyles of high-income countries are major drivers of these twin processes. Our objective is to highlight the common causes of chronic disease and environmental change and, thereby, contribute to shared perspectives across public health and the environment.

STUDY DESIGN

Integrative reviews focused on social determinants and lifestyles as two 'bridging' concepts between the fields of public health and environmental sustainability.

METHODS

We drew on established frameworks to consider the position of the natural environment within social determinants of health (SDH) frameworks and the position of social determinants within environmental frameworks. We drew on evidence on lifestyle factors central to both public health and environmental change (mobility- and diet-related factors). We investigated how public health's focus on individual behaviour can be enriched by environmental perspectives that give attention to household consumption practices.

RESULTS

While SDH frameworks can incorporate the biophysical environment, their causal structure positions it as a determinant and one largely separate from the social factors that shape it. Environmental frameworks are more likely to represent the environment and its ecosystems as socially determined. A few frameworks also include human health as an outcome, providing the basis for a combined public health/environmental sustainability framework. Environmental analyses of household impacts broaden public health's concern with individual risk behaviours, pointing to the more damaging lifestyles of high-income households.

CONCLUSION

The conditions for health are being undermined by rapid environmental change. There is scope for frameworks reaching across public health and environmental sustainability and a shared evidence base that captures the health- and environmentally damaging impacts of high-consumption lifestyles.

Are We Suffering from an Undiagnosed Health Right?

"[T]he assumption that rights are in this sense natural is simply one assumption to be made and examined for its power to unite and explain our political convictions, one basic programmatic decision to submit to this test of coherence and experience." ¹.

Sustainable, healthy cities: making the most of the urban transition

The world is undergoing a massive urban transition, which is now both the greatest driver of global environmental change and the most significant influence on human health. Cities offer real opportunities for improving health, but managed poorly, they can also create or reinforce significant health deficits while putting severe stresses on the natural systems which support human civilization. Management of urban problems is rarely straightforward, as complexity across scales and sectors, in causal structures, actors and incentives, can lead to ineffective policies and unintended consequences. Systems thinking offers a promising way forward in its ability to deal with non-linear relationships and simultaneous actions and outcomes. Encompassing, on the one hand, analytic frameworks and methods that can provide important causal insights and a test bed for urban policy, and on the other, broad processes of inter- and trans-disciplinary engagement to better define problems and feasible solutions, systems approaches are critical to the current and future design and management of sustainable healthy cities.

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015

BACKGROUND

Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.

METHODS

We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).

FINDINGS

Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.

INTERPRETATION

At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.

FUNDING

Bill & Melinda Gates Foundation.

NUTRItion and CLIMate (NUTRICLIM): investigating the relationship between climate variables and childhood malnutrition through agriculture, an exploratory study in Burkina Faso

Malnutrition remains a leading cause of death in children in low- and middle-income countries; this will be aggravated by climate change. Annually, 6.9 million deaths of children under 5 were attributable directly or indirectly to malnutrition. Although these figures have recently decreased, evidence shows that a world with a medium climate (local warming up to 3-4 °C) will create an additional 25.2 million malnourished children. This proof of concept study explores the relationships between childhood malnutrition (more specifically stunting), regional agricultural yields, and climate variables through the use of remote sensing (RS) satellite imaging along with algorithms to predict the effect of climate variability on agricultural yields and on malnutrition of children under 5. The success of this proof of purpose study, NUTRItion and CLIMate (NUTRICLIM), should encourage researchers to apply both concept and tools to study of the link between weather variability, crop yield, and malnutrition on a larger scale. It would also allow for linking such micro-level data to climate models and address the challenge of projecting the additional impact of childhood malnutrition from climate change to various policy relevant time horizons.

Addressing challenges to human health in the Anthropocene epoch-an overview of the findings of the Rockefeller/Lancet Commission on Planetary Health

The report of the Rockefeller Foundation/Lancet Commission on Planetary Health described how human health directly depends upon the environment. It takes a broad perspective not only acknowledging climate change as the most important global environmental threat to health but also recognizing other impacts, including dramatic loss of tropical forests, land degradation, loss of biodiversity, declining freshwater resources, ocean acidification, and over-exploitation of fisheries. All pose challenges to human health gains, leading to the concept of planetary health—that the human condition is tied to natural systems. The Planetary Health Commission report highlights several major concerns arising from environmental change including impacts on food availability and quality, increases in natural disasters and population displacement, and newly emerging diseases, e.g. from zoonotic infections. Three challenges emerge from the report: the first is imagination, or conceptual challenges—better metrics are needed to assess human progress within the context of environmental change; the second is a lack of relevant knowledge, requiring more research on the inter-linkages between environmental change and health and on the effectiveness of potential solutions; and the third is implementation of solutions, ensuring that the science is translated into policy and practice. There are many opportunities to promote planetary health including developing sustainable and healthy cities, encouraging more resilient health systems and disaster preparedness, reducing food waste, preserving ecosystems, and redirecting harmful subsidies in food, agriculture, fishery and energy sectors. Many current trends are driven by inequitable, inefficient, and unsustainable patterns of resource consumption and technological development, coupled with population growth, but solutions lie within reach. Prosperity must be redefined as an enhancement of the quality of life and the delivery of improved health for all, together with respect for natural systems.

Bushmeat hunting and extinction risk to the world's mammals

Terrestrial mammals are experiencing a massive collapse in their population sizes and geographical ranges around the world, but many of the drivers, patterns and consequences of this decline remain poorly understood. Here we provide an analysis showing that bushmeat hunting for mostly food and medicinal products is driving a global crisis whereby 301 terrestrial mammal species are threatened with extinction. Nearly all of these threatened species occur in developing countries where major coexisting threats include deforestation, agricultural expansion, human encroachment and competition with livestock. The unrelenting decline of mammals suggests many vital ecological and socio-economic services that these species provide will be lost, potentially changing ecosystems irrevocably. We discuss options and current obstacles to achieving effective conservation, alongside consequences of failure to stem such anthropogenic mammalian extirpation. We propose a multi-pronged conservation strategy to help save threatened mammals from immediate extinction and avoid a collapse of food security for hundreds of millions of people.

Politics, Power, Poverty and Global Health: Systems and Frames

Striking disparities in access to healthcare and in health outcomes are major characteristics of health across the globe. This inequitable state of global health and how it could be improved has become a highly popularized field of academic study. In a series of articles in this journal the roles of power and politics in global health have been addressed in considerable detail. Three points are added here to this debate. The first is consideration of how the use of definitions and common terms, for example 'poverty eradication,' can mask full exposure of the extent of rectification required, with consequent failure to understand what poverty eradication should mean, how this could be achieved and that a new definition is called for. Secondly, a criticism is offered of how the term 'global health' is used in a restricted manner to describe activities that focus on an anthropocentric and biomedical conception of health across the world. It is proposed that the discourse on 'global health' should be extended beyond conventional boundaries towards an ecocentric conception of global/planetary health in an increasingly interdependent planet characterised by a multitude of interlinked crises. Finally, it is noted that the paucity of workable strategies towards achieving greater equity in sustainable global health is not so much due to lack of understanding of, or insight into, the invisible dimensions of power, but is rather the outcome of seeking solutions from within belief systems and cognitive biases that cannot offer solutions. Hence the need for a new framing perspective for global health that could reshape our thinking and actions.

Understanding the systemic nature of cities to improve health and climate change mitigation

Understanding cities comprehensively as systems is a costly challenge and is typically not feasible for policy makers. Nevertheless, focusing on some key systemic characteristics of cities can give useful insights for policy to advance health and well-being outcomes. Moreover, if we take a coevolutionary systems view of cities, some conventional assumptions about the nature of urban development (e.g. the growth in private vehicle use with income) may not stand up. We illustrate this by examining the coevolution of urban transport and land use systems, and institutional change, giving examples of policy implications. At a high level, our concern derives from the need to better understand the dynamics of urban change, and its implications for health and well-being. At a practical level, we see opportunities to use stylised findings about urban systems to underpin policy experiments. While it is now not uncommon to view cities as systems, policy makers appear to have made little use so far of a systems approach to inform choice of policies with consequences for health and well-being. System insights can be applied to intelligently anticipate change - for example, as cities are subjected to increasing natural system reactions to climate change, they must find ways to mitigate and adapt to it. Secondly, systems insights around policy cobenefits are vital for better informing horizontal policy integration. Lastly, an implication of system complexity is that rather than seeking detailed, 'full' knowledge about urban issues and policies, cities would be well advised to engage in policy experimentation to address increasingly urgent health and climate change issues.

Biodiversity, the Human Microbiome and Mental Health: Moving toward a New Clinical Ecology for the 21st Century?

Advances in research concerning the brain-related influences of the microbiome have been paradigm shifting, although at an early stage, clinical research involving beneficial microbes lends credence to the notion that the microbiome may be an important target in supporting mental health (defined here along the continuum between quality of life and the criteria for specific disorders). Through metagenomics, proteomics, metabolomics, and systems biology, a new emphasis to personalized medicine is on the horizon. Humans can now be viewed as multispecies organisms operating within an ecological theatre; it is important that clinicians increasingly see their patients in this context. Historically marginalized ecological aspects of health are destined to become an important consideration in the new frontiers of practicing medicine with the microbiome in mind. Emerging evidence indicates that macrobiodiversity in the external environment can influence mental well-being. Local biodiversity may also drive differences in human-associated microbiota; microbial diversity as a product of external biodiversity may have far-reaching effects on immune function and mood. With a focus on the microbiome as it pertains to mental health, we define environmental “grey space” and emphasize a new frontier involving bio-eco-psychological medicine. Within this concept the ecological terrain can link dysbiotic lifestyles and biodiversity on the grand scale to the local human-associated microbial ecosystems that might otherwise seem far removed from one another.

Socioeconomic and demographic drivers of red and processed meat consumption: implications for health and environmental sustainability

Red and processed meat (RPM) intake varies widely globally. In some high-income countries (HIC) the last decade has witnessed an overall decline or stabilisation in the consumption of RPM, in contrast to emerging economies where its consumption continues to increase with rising income and rapid urbanisation. The production and consumption of RPM have become major concerns regarding the environmental impacts of livestock in particular, but also because of associations between high RPM consumption and diet-related non-communicable disease. Therefore, it is important to identify socioeconomic and demographic drivers of the consumption of RPM. This paper explores how consumption of RPM differs with age, gender, socioeconomic status and in different global contexts. There are some key socioeconomic and demographic patterns in RPM consumption. Men tend to consume RPM more often and in higher quantities, and there is evidence of a social gradient in HIC, with lower socioeconomic groups consuming RPM more often and in larger quantities. Patterns for consumption with age are less clear cut. It is apparent that consumers in HIC are still consuming high levels of RPM, although the downward shifts in some socioeconomic and demographic groups is encouraging and suggests that strategies could be developed to engage those consumers identified as high RPM consumers. In low- and middle-income countries, RPM consumption is rising, especially in China and Brazil, and in urban areas. Ways of encouraging populations to maintain their traditional healthy eating patterns need to be found in low- and middle-income countries, which will have health, environmental and economic co-benefits.

Sounding the Alarm: Health in the Anthropocene

There is growing scientific and public recognition that human actions, directly and indirectly, have profoundly changed the Earth system, in a still accelerating process, increasingly called the "Anthropocene". Planetary transformation, including of the atmosphere, climate, ecosystems and biodiversity, has enormous implications for human health, many of which are deeply disturbing, especially in low-income settings. A few health consequences of the Anthropocene have been partially recognized, including within environmental epidemiology, but their long-term consequences remain poorly understood and greatly under-rated. For example Syria could be a "sentinel" population, giving a glimpse to a much wider dystopian future. Health-Earth is a research network, co-founded in 2014, which seeks, with other groups, to catalyse a powerful curative response by the wider health community. This paper builds on a symposium presented by Health-Earth members at the 2015 conference of the International Society for Environmental Epidemiology. It reviews and synthesizes parts of the large literature relevant to the interaction between the changing Earth system and human health. It concludes that this topic should be prominent within future environmental epidemiology and public health. Created by our species, these challenges may be soluble, but solutions require far more understanding and resources than are currently being made available.

Building Interdisciplinary Research Capacity: a Key Challenge for Ecological Approaches in Public Health

The shortcomings of public health research informed by reductionist and fragmented biomedical approaches and the emergence of wicked problems are fueling a renewed interest in ecological approaches in public health. Despite the central role of interdisciplinarity in the context of ecological approaches in public health research, inadequate attention has been given to the specific challenge of doing interdisciplinary research in practice. As a result, important knowledge gaps exist with regards to the practice of interdisciplinary research. We argue that explicit attention towards the challenge of doing interdisciplinary research is critical in order to effectively apply ecological approaches to public health issues. This paper draws on our experiences developing and conducting an interdisciplinary research project exploring the links among climate change, water, and health to highlight five specific insights which we see as relevant to building capacity for interdisciplinary research specifically, and which have particular relevance to addressing the integrative challenges demanded by ecological approaches to address public health issues. These lessons include: (i) the need for frameworks that facilitate integration; (ii) emphasize learning-by-doing; (iii) the benefits of examining issues at multiple scales; (iv) make the implicit, explicit; and (v) the need for reflective practice. By synthesizing and sharing experiences gained by engaging in interdisciplinary inquiries using an ecological approach, this paper responds to a growing need to build interdisciplinary research capacity as a means for advancing the ecological public health agenda more broadly.

Enabled or Disabled: Is the Environment Right for Using Biodiversity to Improve Nutrition?

How can we ensure that 9 billion people will have access to a nutritious and healthy diet that is produced in a sustainable manner by 2050? Despite major advances, our global food system still fails to feed a significant part of humanity adequately. Diversifying food systems and diets to include nutrient-rich species can help reduce malnutrition, while contributing other multiple benefits including healthy ecosystems. While research continues to demonstrate the value of incorporating biodiversity into food systems and diets, perverse subsidies, and barriers often prevent this. Countries like Brazil have shown that, by strategic actions and interventions, it is indeed possible to create better contexts to mainstream biodiversity for improved nutrition into government programs and public policies. Despite some progress, there are few global and national policy mechanisms or processes that effectively join biodiversity with agriculture and nutrition efforts. This perspective paper discusses the benefits of biodiversity for nutrition and explores what an enabling environment for biodiversity to improve nutrition might look like, including examples of steps and actions from a multi-country project that other countries might replicate. Finally, we suggest what it might take to create enabling environments to mainstream biodiversity into global initiatives and national programs and policies on food and nutrition security. With demand for new thinking about how we improve agriculture for nutrition and growing international recognition of the role biodiversity, the 2030 Agenda for Sustainable Development presents an opportunity to move beyond business-as-usual to more holistic approaches to food and nutrition security.

The pyrohealth transition: how combustion emissions have shaped health through human history

Air pollution from landscape fires, domestic fires and fossil fuel combustion is recognized as the single most important global environmental risk factor for human mortality and is associated with a global burden of disease almost as large as that of tobacco smoking. The shift from a reliance on biomass to fossil fuels for powering economies, broadly described as the pyric transition, frames key patterns in human fire usage and landscape fire activity. These have produced distinct patters of human exposure to air pollution associated with the Agricultural and Industrial Revolutions and post-industrial the Earth global system-wide changes increasingly known as the Anthropocene. Changes in patterns of human fertility, mortality and morbidity associated with economic development have been previously described in terms of demographic, epidemiological and nutrition transitions, yet these frameworks have not explicitly considered the direct consequences of combustion emissions for human health. To address this gap, we propose a pyrohealth transition and use data from the Global Burden of Disease (GBD) collaboration to compare direct mortality impacts of emissions from landscape fires, domestic fires, fossil fuel combustion and the global epidemic of tobacco smoking. Improving human health and reducing the environmental impacts on the Earth system will require a considerable reduction in biomass and fossil fuel combustion.This article is part of the themed issue 'The interaction of fire and mankind'.

Indigenous Food Systems and Climate Change: Impacts of Climatic Shifts on the Production and Processing of Native and Traditional Crops in the Bolivian Andes

Inhabitants of the high-mountain Andes have already begun to experience changes in the timing, severity, and patterning of annual weather cycles. These changes have important implications for agriculture, for human health, and for the conservation of biodiversity in the region. This paper examines the implications of climate-driven changes for native and traditional crops in the municipality of Colomi, Cochabamba, Bolivia. Data were collected between 2012 and 2014 via mixed methods, qualitative fieldwork, including participatory workshops with female farmers and food preparers, semi-structured interviews with local agronomists, and participant observation. Drawing from this data, the paper describes (a) the observed impacts of changing weather patterns on agricultural production in the municipality of Colomi, Bolivia and (b) the role of local environmental resources and conditions, including clean running water, temperature, and humidity, in the household processing techniques used to conserve and sometimes detoxify native crop and animal species, including potato (Solanum sp.), oca (Oxalis tuberosa), tarwi (Lupinus mutabilis), papalisa (Ullucus tuberosus), and charke (llama or sheep jerky). Analysis suggests that the effects of climatic changes on agriculture go beyond reductions in yield, also influencing how farmers make choices about the timing of planting, soil management, and the use and spatial distribution of particular crop varieties. Furthermore, household processing techniques to preserve and detoxify native foods rely on key environmental and climatic resources, which may be vulnerable to climatic shifts. Although these findings are drawn from a single case study, we suggest that Colomi agriculture characterizes larger patterns in what might be termed, "indigenous food systems." Such systems are underrepresented in aggregate models of the impacts of climate change on world agriculture and may be under different, more direct, and more immediate threat from climate change. As such, the health of the food production and processing environments in such systems merits immediate attention in research and practice.

Pacific connections for health, ecosystems and society: new approaches to the land-water-health nexus

Renewed effort to understand the social-ecological context of health is drawing attention to the dynamics of land and water resources and their combined influence on the determinants of health. A new area of research, education and policy is emerging that focuses on the land-water-health nexus: this orientation is applicable from small wetlands through to large-scale watersheds or river basins, and draws attention to the benefits of combined land and water governance, as well as the interrelated implications for health, ecological and societal concerns. Informed by research precedents, imperatives and collaborations emerging in Canada and parts of Oceania, this review profiles three integrative, applied approaches that are bringing attention to the importance the land-water-health nexus within the Pacific Basin: wetlands and watersheds as intersectoral settings to address land-water-health dynamics; tools to integrate health, ecological and societal dynamics at the land-water-health nexus; and indigenous leadership that is linking health and well-being with land and water governance. Emphasis is given to key characteristics of a new generation of inquiry and action at the land-water-health nexus, as well as capacity-building, practice and policy opportunities to address converging environmental, social and health objectives linked to the management and governance of land and water resources.

Global Health Governance Challenges 2016 - Are We Ready?

The year 2016 could turn out to be a turning point for global health, new political realities and global insecurities will test governance and financing mechanisms in relation to both people and planet. But most importantly political factors such as the global power shift and "the rise of the rest" will define the future of global health. A new mix of health inequity and security challenges has emerged and the 2015 humanitarian and health crises have shown the limits of existing systems. The global health as well as the humanitarian system will have to prove their capacity to respond and reform. The challenge ahead is deeply political, especially for the rising political actors. They are confronted with the consequences of a model of development that has neglected sustainability and equity, and was built on their exploitation. Some direction has been given by the path breaking international conferences in 2015. Especially the agreement on the Sustainable Development Goals (SDGs) and the Paris agreement on climate change will shape action. Conceptually, we will need a different understanding of global health and its ultimate goals - the health of people can no longer be seen separate from the health of the planet and wealth measured by parameters of growth will no longer ensure health.

Aumento no uso de transporte motorizado privado no deslocamento das crianças para a escola na Região Metropolitana de São Paulo, Brasil, 1997-2012

Resumo: A Região Metropolitana de São Paulo, Brasil, apresentou, entre 1997 e 2007, tendência de aumento do uso transporte motorizado privado nos deslocamentos de crianças para a escola, com potenciais prejuízos à saúde. O objetivo deste estudo foi ampliar a análise de tal tendência para 2012 e discutir possíveis estratégias para aumentar a proporção de crianças que andam, pedalam e usam o transporte público. A análise dos dados da Pesquisa de Mobilidade de 2012 indica não apenas a continuidade, mas a aceleração no aumento do uso transporte motorizado privado em deslocamentos de crianças entre 6 e 11 anos para a escola. O efeito de iniciativas em andamento sobre essa tendência só será devidamente compreendido com o devido monitoramento dos deslocamentos cotidianos e a avaliação do impacto dessas ações sobre a saúde da população. Um pacote de políticas e programas voltados especificamente para a promoção e proteção da mobilidade a pé, de bicicleta ou por transporte público de crianças é imprescindível para garantir o deslocamento seguro, independente e ativo de crianças para a escola na Região Metropolitana de São Paulo.

Solving the global climate crisis: the greatest health opportunity of our times?

Today's substantial global health gains are being undermined by the threat of climate change. Ironically, the actions required to confront the climate crisis represent possibly the largest public health opportunity in more than a century. Health benefits from improved air quality may far outweigh the cost of clean energy investments. Upward trends in chronic diseases are now occurring throughout the world. Herein lies even more golden opportunities for public health through the following: first, adopting more alternative modes of transportation, especially those that promote "active transport" by foot or by bicycle, in combination with effective public transportation; and second, by reducing meat in the diet. In essence, there is no better time to focus on health as central in the climate negotiations; and in so doing, may we move faster and further with effective actions on climate change and the subsequent health benefits that will arise from a low-carbon society.

Effects of decreases of animal pollinators on human nutrition and global health: a modelling analysis

BACKGROUND

Anthropogenic declines of animal pollinators and the associated effects on human nutrition are of growing concern. We quantified the nutritional and health outcomes associated with decreased intake of pollinator-dependent foods for populations around the world.

METHODS

We assembled a database of supplies of 224 types of food in 156 countries. We quantified nutrient composition and pollinator dependence of foods to estimate the size of possible reductions in micronutrient and food intakes for different national populations, while keeping calorie intake constant with replacement by staple foods. We estimated pollinator-decline-dependent changes in micronutrient-deficient populations using population-weighted estimated average requirements and the cutpoint method. We estimated disease burdens of non-communicable, communicable, and malnutrition-related diseases with the Global Burden of Disease 2010 comparative risk assessment framework.

FINDINGS

Assuming complete removal of pollinators, 71 million (95% uncertainty interval 41-262) people in low-income countries could become newly deficient in vitamin A, and an additional 2.2 billion (1.2-2.5) already consuming below the average requirement would have further declines in vitamin A supplies. Corresponding estimates for folate were 173 million (134-225) and 1.23 billion (1.12-1.33). A 100% decline in pollinator services could reduce global fruit supplies by 22.9% (19.5-26.1), vegetables by 16.3% (15.1-17.7), and nuts and seeds by 22.1% (17.7-26.4), with significant heterogeneity by country. In sum, these dietary changes could increase global deaths yearly from non-communicable and malnutrition-related diseases by 1.42 million (1.38-1.48) and disability-adjusted life-years (DALYs) by 27.0 million (25.8-29.1), an increase of 2.7% for deaths and 1.1% for DALYs. A 50% loss of pollination services would be associated with 700,000 additional annual deaths and 13.2 million DALYs.

INTERPRETATION

Declines in animal pollinators could cause significant global health burdens from both non-communicable diseases and micronutrient deficiencies.

FUNDING

Winslow Foundation, Bill & Melinda Gates Foundation.

Climate Change Effects on Heat- and Cold-Related Mortality in the Netherlands: A Scenario-Based Integrated Environmental Health Impact Assessment

Although people will most likely adjust to warmer temperatures, it is still difficult to assess what this adaptation will look like. This scenario-based integrated health impacts assessment explores baseline (1981–2010) and future (2050) population attributable fractions (PAF) of mortality due to heat (PAF_heat) and cold (PAF_cold), by combining observed temperature–mortality relationships with the Dutch KNMI’14 climate scenarios and three adaptation scenarios. The 2050 model results without adaptation reveal a decrease in PAF_cold (8.90% at baseline; 6.56%–7.85% in 2050) that outweighs the increase in PAF_heat (1.15% at baseline; 1.66%–2.52% in 2050). When the 2050 model runs applying the different adaptation scenarios are considered as well, however, the PAF_heat ranges between 0.94% and 2.52% and the PAF_cold between 6.56% and 9.85%. Hence, PAF_heat and PAF_cold can decrease as well as increase in view of climate change (depending on the adaptation scenario). The associated annual mortality burdens in 2050—accounting for both the increasing temperatures and mortality trend—show that heat-related deaths will range between 1879 and 5061 (1511 at baseline) and cold-related deaths between 13,149 and 19,753 (11,727 at baseline). Our results clearly illustrate that model outcomes are not only highly dependent on climate scenarios, but also on adaptation assumptions. Hence, a better understanding of (the impact of various) plausible adaptation scenarios is required to advance future integrated health impact assessments.

Climate Change and Children's Health: A Commentary

This commentary describes the likely impacts on children's health and wellbeing from climate change, based on the solid science of environmental child health. It describes likely climate change scenarios, why children are more vulnerable than older people to these changes, and what to expect in terms of diseases (e.g., infections, asthma) and problems (e.g., malnutrition, mental illness). The common antecedents of climate change and other detrimental changes to our society mean that in combatting them (such as excessive consumption and greed), we may not only reduce the harmful effects of climate change but also work towards a better society overall—one that values its children and their futures.

Is a Cardio-Protective Diet Sustainable? A Review of the Synergies and Tensions Between Foods That Promote the Health of the Heart and the Planet

There are many synergies between a diet that is healthy for the heart and one that is healthy for the planet, but there may also be tensions. We examined the Barilla Center for Food and Nutrition’s double pyramid to describe the carbon, water, and ecological footprints of the components of a cardio-protective diet. Overall, fruits, vegetables, and whole grains all tend to have low carbon and water footprints, while nuts and olive oil have relatively higher water footprints and fish have a high ecological footprint. In order to increase the sustainability of a cardio-protective diet, consumers can choose nuts (e.g., walnuts) and oils (e.g., sunflower) with lower water footprints and sustainably produced fish. However, in order to increase consumption of these foods, parallel efforts should be implemented targeting consumer knowledge and incentives to make these foods more affordable.