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

Emerging and re-emerging pediatric viral diseases: a continuing global challenge

The twenty-first century has been marked by a surge in viral epidemics and pandemics, highlighting the global health challenge posed by emerging and re-emerging pediatric viral diseases. This review article explores the complex dynamics contributing to this challenge, including climate change, globalization, socio-economic interconnectedness, geopolitical tensions, vaccine hesitancy, misinformation, and disparities in access to healthcare resources. Understanding the interactions between the environment, socioeconomics, and health is crucial for effectively addressing current and future outbreaks. This scoping review focuses on emerging and re-emerging viral infectious diseases, with an emphasis on pediatric vulnerability. It highlights the urgent need for prevention, preparedness, and response efforts, particularly in resource-limited communities disproportionately affected by climate change and spillover events. Adopting a One Health/Planetary Health approach, which integrates human, animal, and ecosystem health, can enhance equity and resilience in global communities. IMPACT: We provide a scoping review of emerging and re-emerging viral threats to global pediatric populations This review provides an update on current pediatric viral threats in the context of the COVID-19 pandemic This review aims to sensitize clinicians, epidemiologists, public health practitioners, and policy stakeholders/decision-makers to the role these viral diseases have in persistent pediatric morbidity and mortality.

Associations between climate change-related factors and sexual health: A scoping review

There is growing attention to the ways in which climate change may affect sexual health, yet key knowledge gaps remain across global contexts and climate issues. In response, we conducted a scoping review to examine the literature on associations between climate change and sexual health. We searched five databases (May 2021, September 2022). We reviewed 3,183 non-duplicate records for inclusion; n = 83 articles met inclusion criteria. Of these articles, n = 30 focused on HIV and other STIs, n = 52 focused on sexual and gender-based violence (GBV), and n = 1 focused on comprehensive sexuality education. Thematic analysis revealed that hurricanes, drought, temperature variation, flooding, and storms may influence HIV outcomes among people with HIV by constraining access to antiretroviral treatment and worsening mental health. Climate change was associated with HIV/STI testing barriers and worsened economic conditions that elevated HIV exposure (e.g. transactional sex). Findings varied regarding associations between GBV with storms and drought, yet most studies examining flooding, extreme temperatures, and bushfires reported positive associations with GBV. Future climate change research can examine understudied sexual health domains and a range of climate-related issues (e.g. heat waves, deforestation) for their relevance to sexual health. Climate-resilient sexual health approaches can integrate extreme weather events into programming.

From biodiversity to nature deficiency in human health and disease

Nature (biodiversity) loss is the loss or decline of the state of nature taking place in the wider environment. We present a novel concept, nature deficiency, referring to nature loss in the human body influencing health. Humans are connected with the natural environment and its microbes and biogenic chemicals through eating (drinking), breathing, and touching. The mental and sociocultural links to the environment are also strong. With medical and ecological research and guidelines, the diagnosis, prevention, and treatment of nature deficiency may become part of the clinical practice. Nature prescription is likely to find plausible forms in patient care and inspire preventive actions at the society level. Health professionals are in a key position to integrate public health promotion and environmental care.

Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework

BACKGROUND

The health sector contributes significantly to the climate crisis. Operating theatres (OTs) in particular are a major contributor of greenhouse gas emissions and waste, and while there are several evidence-based guidelines to reduce this impact, these are often not followed. The authors systematically reviewed the literature to identify barriers and facilitators of sustainable behaviour in OTs, categorising these using the Theoretical Domains Framework (TDF).

MATERIALS AND METHODS

Medline, Embase, PsychInfo, and Global Health databases were searched for articles published between January 2000 and June 2023, using the concepts: barriers and facilitators, sustainability, and surgery. Two reviewers screened abstracts from identified studies, evaluated quality, and extracted data. Identified determinants were mapped to TDF domains and further themes as required. The results were reported in line with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and AMSTAR (A MeaSurement Tool to Assess Systematic Reviews) guidelines.

RESULTS

Twenty-one studies were selected for analysis and assessment (17 surveys and four interview studies) comprising 8286 participants, including surgeons, nurses, and anaesthetists. Eighteen themes across 10 TDF domains were identified. The most common barriers to adoption of green behaviours in OTs were in domains of: 'knowledge' ( N =18), for example knowledge of sustainable practices; 'environmental context and resources' ( N =16) for example personnel shortage and workload and inadequate recycling facilities; 'social influences' ( N =9) for example lack of leadership/organisational mandate or support; 'beliefs about consequences' ( N =9) for example concerns regarding safety. Intention was the most common facilitator, with 11 studies citing it.

CONCLUSIONS

Despite intentions to adopt sustainable practices in OTs, this review identified several barriers to doing so. Interventions should focus on mitigating these, especially by improving staff's knowledge of sustainability practices and working within the environmental context and time pressures. Furthermore, institutional change programmes and policies are needed to prioritise sustainability at the hospital and trust level. Additional qualitative work should also be conducted using behavioural frameworks, to more comprehensively investigate barriers and determinants to decarbonise OTs.

Cost Savings and Waste Reduction Through Redispensing Unused Oral Anticancer Drugs: The ROAD Study

Importance

New strategies targeting waste are required to improve financial and ecologic sustainability of expensive therapies, such as oral anticancer drugs, that frequently remain unused by patients. Redispensing unused oral anticancer drugs seems to be a promising strategy when drug quality is guaranteed.

Objectives

To determine the waste reduction and net cost savings attained by redispensing oral anticancer drugs that go unused by patients compared with the standard practice of disposal.

Design, Settings, and Participants

The ROAD study was a prospective single-group intervention conducted in the outpatient pharmacies of 4 hospitals in the Netherlands from February 1, 2021, to February 1, 2023, with 12-month follow-up of each patient. Patients with cancer and who had a prescription for an oral anticancer drug that could be stored at room temperature were included. Of 2426 eligible patients, 602 did not consent and 601 did not respond. Data analyses were performed from August 25, 2022, to April 19, 2023.

Intervention

Participants received oral anticancer drugs for use at home in special packaging (ie, sealed packaging with time-temperature indicator), to be returned to the pharmacy should these remain unused. The pharmacy ensured quality of returned drugs based on authenticity, appearance, remaining shelf life and adequate storage temperature. Drugs fulfilling quality requirements were redispensed to other patients.

Main Outcome and Measure

Total waste reduction and mean net annual cost savings per patient compared with the standard practice of disposal. Optimization of cost savings was explored by introducing variations in the quality assurance procedure and patient population. All analyses used the average exchange rate for 2021 €1 = US $1.18.

Results

Of 1223 patients with cancer who consented, 1071 participated (median [IQR] age, 70 [62-75] years; 622 [58.1%] were male). In all, 171 patients (16.0%; 95% CI, 13.8%-18.3%) returned 335 unused oral anticancer drug packages. Of the returned drugs, 228 packages were redispensed, which reduced waste by 68.1% (95% CI, 67.7%-68.5%) compared with the standard practice (disposal). Redispensing unused oral anticancer drugs comprised 2.4% (95% CI, 2.2%-2.5%) of total drug costs, providing mean net annual cost savings of US $680 (95% CI, $524-$837) up to $1591 (95% CI, $1226-$2002) per participant.

Conclusions and Relevance

The findings of this multicenter intervention study indicate that redispensing unused oral anticancer drugs is associated with waste reduction and cost savings, which in turn may improve the affordability and sustainability of cancer treatment.

Trial Registration

World Health Organization International Clinical Trials Registry Platform Identifier: NL9208.

The development of ecological civilization in China based on the economic-social-natural complex system

China is making great efforts to build an ecological civilization. To reveal the effectiveness and spatial characteristics of the ecological civilization development in China, we constructed an Ecological Civilization Evaluation Index (ECI) based on the economic-social-natural complex system. We evaluated the development level of the ecological civilization in China from 2004 to 2020 and discussed the coupling and coordination relationship between subsystems. We found that the ecological civilization of China has achieved remarkable results. The relationship among the three subsystems has been improved to some extent, but the high-quality development of the economic system still requires effort. The development level of the ecological civilization in China presents spatial heterogeneity. From east to west, 30 provinces can be classified into four different types of development. On the whole, the development of China's ecological civilization has provided experiences for the world.

The role of mental health nurses in planetary health

This article will critically explore the concept of planetary health and locate the role and identity of the mental health nurse (MHN) within it. Like humans, our planet thrives in optimum conditions, finding the delicate balance between health and ill-health. Human activity is now negatively impacting the homeostasis of the planet and this imbalance creates external stressors that adversely impact upon human physical and mental health at the cellular level. The value and understanding of this intrinsic relationship between human health and the planet is in danger of being lost within a society that views itself as being separate and superior to nature. The Period of Enlightenment witnessed some human groups viewing the natural world and its resources as something to exploit. White colonialism and industrialization destroyed the innate symbiotic relationship between humans and the planet beyond recognition and in particular, overlooking the essential therapeutic role nature and the land facilitated within the well-being of individuals and communities. This prolonged loss of respect for the natural world continues to breed human disconnection on a global scale. The healing properties of nature have effectively been abandoned within healthcare planning and infrastructure, which continue to be driven principally by the medical model. Under the theory of holism, mental health nursing values the restorative capabilities of connection and belonging, employing skills to support the healing of suffering, trauma and distress, through relationships and education. This suggests MHNs are well situated to provide the advocacy the planet requires, through the active promotion of connecting communities to the natural world around them, both healing the other.

Financial influence on global risks of zoonotic emerging and re-emerging diseases: an integrative analysis

BACKGROUND

Emerging and re-emerging infectious diseases (EIDs), such as Ebola virus disease and highly pathogenic influenza, are serious threats to human health and wellbeing worldwide. The financial sector has an important, yet often ignored, influence as owners and investors in industries that are associated with anthropogenic land-use changes in ecosystems linked to increased EIDs risks. We aimed to analyse financial influence associated with EIDs risks that are affected by anthropogenic land-use changes. We also aimed to provide empirical assessments of such influence to help guide engagements by governments, private organisations, and non-governmental organisations with the financial sector to advance a planetary health agenda.

METHODS

For this integrative analysis, we identified regions in the world where there was evidence of a connection between EIDs and anthropogenic land-use changes between Nov 9, 1999, and Oct 25, 2021, through a targeted literature review of academic literature and grey literature to identify evidence of drivers of anthropogenic land-use change and their association with commodity production in these regions. We only included publications in English that showed a connection between deforestation and the production of one or more commodities. Publications merely describing spatial or temporal land-use change dynamics (eg, a reduction of forest or an increase of palm-oil plantations) were excluded. As we were assessing financial influence on corporate activities through ownership specifically, we focused our analysis on publicly listed companies. Equity data and data about ownership structure were extracted from Orbis, a company information database. We assessed financial influence by identifying financial entities with the largest equity ownership, descriptively mapping transboundary connections between investors and publicly listed companies.

FINDINGS

227 public and private companies operating in five economic sectors (ie, production of palm oil, pulp and wood products, cocoa, soybeans, and beef) between Dec 15, 2020, and March 8, 2021, were identified. Of these 227, 99 (44%) were publicly listed companies, with 2310 unique shareholders. These publicly listed companies operated in six geographical regions, resulting in nine case-study regions. 54 (55%) companies with complete geographical information were included in the countries network. Four financial entities (ie, Dimensional, Vanguard, BlackRock, and Norway's sovereign wealth fund) each had ownership in 39 companies or more in three of the case-study regions (ie, north America, east Asia, and Europe). Four large US-based asset managers (ie, Vanguard, BlackRock, T Rowe Price, and State Street) were the largest owners of publicly listed companies in terms of total equity size, with ownership amounts for these four entities ranging from US$8 billion to $21 billion. The specific patterns of cross-national ownership depended on the region of interest; for example, financial influence on EIDs risks that was associated with commodity production in southeast and east Asia came from not only global asset managers but also Malaysian, Chinese, Japanese, and Korean financial entities. India, Brazil, the USA, Mexico, and Argentina were the countries towards which investments were most directed.

INTERPRETATION

Although commodity supply chains and financial markets are highly globalised, a small number of investors and countries could be viewed as disproportionally influential in sectors that increase EIDs risks. Such financial influence could be used to develop and implement effective policies to reduce ecological degradation and mitigate EIDs risks and their effects on population health.

FUNDING

Formas and Networks of Financial Rupture-how cascading changes in the climate and ecosystems could impact on the financial sector.

Sustainable diets among youth: Validity and reliability of a questionnaire assessing knowledge, attitudes, practices, and willingness to change

BACKGROUND

In light of the global commitment to promoting sustainable dietary choices and the pivotal role of young adults in the adoption of these choices, it is paramount to understand their perspectives of healthy and sustainable diets. The present study aimed to investigate the validity and reliability of a questionnaire examining the knowledge, attitudes, practices, and willingness to change regarding sustainable diets among young adults in the United Arab Emirates (UAE).

METHODS

Male and female students attending University of Sharjah, UAE (n = 436), completed an online questionnaire consisting of four sections: knowledge, attitudes, practices, and willingness to change with regard to sustainable diets. Of the participants, 106 completed the questionnaire a second time, 1 month later. Factor analysis (FA) (both exploratory and confirmatory), Cronbach-α, interitem correlations, and intra class correlation (ICC) coefficients were used in the data analysis.

RESULTS

Exploratory FA revealed four factors corresponding to the components of the questionnaire. Results of the confirmatory FA indicated a good fit: the χ2 df ratio was < 5 (2.3), root mean squared error of approximation was < 0.08 (0.048) and the comparative fit index was above 0.9 (0.901). Cronbach α and interitem correlations were: knowledge: 0.57 and 0.21; attitude: 0.70 and 0.28; practices: 0.76 and 0.39; willingness to change: 0.69 and 0.27. The ICC coefficients, assessing the reliability of the questionnaire, ranged between 0.48 and 0.92 for the various items.

CONCLUSIONS

The developed questionnaire is a valid and reliable tool that could be used to identify the gaps and opportunities for the development of evidence-based interventions aiming to enhance the uptake of sustainable diets among young adults.

A systems science leverage point analysis of climate change advocacy

Failure of governments across the world to address climate change has fuelled social movements focused on climate-related policy and action. Research analysing these movements has focused mainly on the types of strategies employed including blockades and occupations, marches and petitions, divestment, boycotts and litigation as well as how groups are framing climate change as a problem. What has been largely missed are the ways these groups are framing the change they want to see, that is their demands to governments. Not all demands and actions have the same potential to create the changes needed to mitigate climate change. Used in public health and health promotion, the systems science Intervention Level Framework (ILF) is a tool that can help analyse to what extent different demands have the leverage to create change in a system. We use the ILF to analyse 131 demands from 35 different climate-related advocacy groups in Australia. Results show demands are more focused on lower system leverage points, such as stopping particular projects, rather than on more impactful leverage points, such as the governance structures that determine climate-related policy and decision-making mechanisms. Further, the results highlight the lack of attention on public health related topics of transport and food systems. This paper shows how a systems science framework used in health promotion, the ILF, could enable climate advocacy groups to more effectively target demands to achieve more impactful outcomes from governments, corporations and the public.

The mental health impacts of human-ecosystem-animal relationships: A systematic scoping review of Eco-, Planetary, and One Health approaches

The threats to human and animal health, biodiversity conservation, and our living planet's future are ever-present and increasingly more severe due to climate change and environmental degradation. There is an emerging discourse exploring the mental health dimensions contained within these changes. To better understand and respond to these impacts requires novel and creative methodological approaches built on conceptual frameworks that integrate perspectives from the social and natural sciences. Three of the most influential interdisciplinary frameworks at the human-animal-ecosystem interface include: One Health, EcoHealth, and Planetary Health. These frameworks report mental health as an integral component within overall health-related outcomes. However, a comprehensive synthesis of the state of the literature that examines how mental health is explored within these approaches does not currently exist. A systematic scoping review was therefore conducted to obtain clear understandings of patterns, gaps, and broad themes, and to highlight future research needs and considerations. Standardized PRISMA guidelines, including explicitly defined inclusion/exclusion criteria and dual screening/extractions, were used. 13 papers were included: seven using the One Health Framework, with Planetary and EcoHealth each represented by three. Trends observed include a predominate focus on companion animals as interventions, "sense of place" used as a component of mental well-being, and non-physical health-related measurements of animal well-being as an outcome within One Health research. The lack in retrieved studies also highlight the dearth in literature on mental health as a pillar of these three well established frameworks. Compiling what is known in the evidence-base as a launching point for scientific engagement, this review describes guidance for investigators on how to conduct mental health research within these framework parameters so that future studies can elucidate mechanisms underpinning the intersections between the biosphere and human mental-health and data-driven interventions and policy recommendations that simultaneously address mental health and global change can be proposed and enacted.

What Are Healthy Societies? A Thematic Analysis of Relevant Conceptual Frameworks

BACKGROUND

While support for the idea of fostering healthy societies is longstanding, there is a gap in the literature on what they are, how to beget them, and how experience might inform future efforts. This paper explores developments since Alma Ata (1978) to understand how a range of related concepts and fields inform approaches to healthy societies and to develop a model to help conceptualize future research and policy initiatives.

METHODS

Drawing on 68 purposively selected documents, including political declarations, commission and agency reports, peer-reviewed papers and guidance notes, we undertook qualitative thematic analysis. Three independent researchers compiled and categorised themes describing the domains of a potential healthy societies approach.

RESULTS

The literature provides numerous frameworks. Some of these frameworks promote alternative endpoints to development, eschewing short-term economic growth in favour of health, equity, well-being and sustainability. They also identify values, such as gender equality, collaboration, human rights and empowerment that provide the pathways to, or underpin, such endpoints. We categorize the literature into four "components": people; places; products; and planet. People refers to social positions, interactions and networks creating well-being. Places are physical environments-built and natural-and the interests and policies shaping them. Products are commodities and commercial practices impacting population health. Planet places human health in the context of the 'Anthropocene.' These components interact in complex ways across global, regional, country and community levels as outlined in our heuristic.

CONCLUSION

The literature offers little critical reflection on why greater progress has not been made, or on the need to organise and resist the prevailing systems which perpetuate ill-health.

How to Build Healthy Societies: A Thematic Analysis of Relevant Conceptual Frameworks

BACKGROUND

As the Sustainable Development Goals deadline of 2030 draws near, greater attention is being given to health beyond the health sector, in other words, to the creation of healthy societies. However, action and reform in this area has not kept pace, in part due to a focus on narrower interventions and the lack of upstream action on health inequity. With an aim to guide action and political engagement for reform, we conducted a thematic analysis of concepts seeking to arrive at healthy societies.

METHODS

This paper drew on a qualitative thematic analysis of a purposive sample of 68 documents including political declarations, reports, peer reviewed literature and guidance published since 1974. Three independent reviewers extracted data to identify, discuss and critique public policy levers and 'enablers' of healthy societies, the "how."

RESULTS

The first lever concerned regulatory and fiscal measures. The second was intersectoral action. The final lever a shift in the global consensus around what signifies societal transformation and outcomes. The three enablers covered political leadership and accountability, popular mobilization and the generation and use of knowledge.

CONCLUSION

Documents focused largely on technical rather than political solutions. Even as the importance of political leadership was recognized, analysis of power was limited. Rights-based approaches were generally neglected as was assessing what worked or did not work to pull the levers or invest in the enablers. Frameworks typically failed to acknowledge or challenge prevailing ideologies, and did not seek to identify ways to hold or governments or corporations accountable for failures. Finally, ideas and approaches seem to recur again over the decades, without adding further nuance or analysis. This suggests a need for more upstream, critical and radical approaches to achieve healthy societies.

Nature-based biopsychosocial resilience: An integrative theoretical framework for research on nature and health

Nature-based solutions including urban forests and wetlands can help communities cope better with climate change and other environmental stressors by enhancing social-ecological resilience. Natural ecosystems, settings, elements and affordances can also help individuals become more personally resilient to a variety of stressors, although the mechanisms underpinning individual-level nature-based resilience, and their relations to social-ecological resilience, are not well articulated. We propose 'nature-based biopsychosocial resilience theory' (NBRT) to address these gaps. Our framework begins by suggesting that individual-level resilience can refer to both: a) a person's set of adaptive resources; and b) the processes by which these resources are deployed. Drawing on existing nature-health perspectives, we argue that nature contact can support individuals build and maintain biological, psychological, and social (i.e. biopsychosocial) resilience-related resources. Together with nature-based social-ecological resilience, these biopsychosocial resilience resources can: i) reduce the risk of various stressors (preventive resilience); ii) enhance adaptive reactions to stressful circumstances (response resilience), and/or iii) facilitate more rapid and/or complete recovery from stress (recovery resilience). Reference to these three resilience processes supports integration across more familiar pathways involving harm reduction, capacity building, and restoration. Evidence in support of the theory, potential interventions to promote nature-based biopsychosocial resilience, and issues that require further consideration are discussed.

Aligning Environmental Sustainability, Health Outcomes, and Affordability in Diet Quality: A Systematic Review

Improving diet quality while simultaneously maintaining planetary health is of critical interest globally. Despite the shared motivation, advancement remains slow, and the research community continues to operate in silos, focusing on certain pairings (diet-climate), or with a discipline-specific lens of a sustainable diet, rather than examining their totality. This review aimed to summarize the literature on adherence to a priori defined dietary patterns in consideration of diet quality, metabolic risk factors for noncommunicable diseases (NCDs), environmental impacts, and affordability. A methodology using PRISMA guidelines was followed, and searches were performed in 7 databases as of October 2022. The Appraisal tool for Cross-Sectional Studies (AXIS) and the National Institutes of Health (NIH) quality assessment tool for observational cohort studies were employed for quality appraisal. The evidence was narratively synthesized according to the characteristics of the diet quality metrics. The review includes 24 studies published between 2017-2023. Thirteen distinct diet quality scores were identified, with those measuring adherence to national dietary guidelines the most reported. Thirteen distinct environmental impact indicators were identified, with greenhouse gas emissions (n=23) reported most. All studies reported on body mass index, and 7 studies assessed the cost of adherence. Our results are consistent with previous findings that healthier diets can reduce environmental impacts; however, incongruities between population and planetary health can occur. Hence, the "sustainability" of dietary patterns is dependent on the choice of indicators selected. Further, healthy, lower impact diets can increase financial cost, but may also provide a protective role against the risk of obesity. Given the Global Syndemic, strategies to reduce obesity prevalence should emphasize the win-win opportunities for population and planetary health through dietary change. Research should identify diets that address multiple environmental concerns to curtail burdens potentially transferring, and harmonize this with sociocultural and equity dimensions. This review was registered at PROSPERO as CRD42021238055.

Planetary Health: Preparing Nursing Students for the Future

BACKGROUND

Climate change around the globe is impacting human and planetary health at unprecedented rates. Nurses are well positioned to act as climate leaders, given their critical role globally.

PROBLEM

Current and future nurses must work to mitigate climate-related health effects. It is necessary that a planetary health approach is integrated into nursing education.

APPROACH

Curricular modifications, using the Planetary Health Education Framework, are presented, which will promote awareness and understanding of climate health among future nurses. The framework is grounded in equity, which is well suited to nursing education, and can be readily adapted into current nursing curricula.

OUTCOMES

Recommendations for nursing education are presented within the 5 domains of the framework.

CONCLUSIONS

Future nurses are called on to be exemplary planetary health communicators, educators, advocates, and leaders. The Planetary Health Education Framework promotes nursing leadership in practice and in advocating for a climate-resistant future.

[Urban green and blue spaces in times of climate change]

Both climate mitigation and adaptation are urgently needed as complementary strategies for sustainably reducing and managing urban health risks posed by climate change. The positive effects of urban green and blue spaces on physical and mental health are well-known since decades. However, there is intensive competition around the use of the urban space. Reflecting the European Aalborg Charta (1994), German building laws require development plans to be sustainable in this demanding context with human health being a concern of central importance. Reality, however, remains challenging. Although there are numerous best practice examples, research on the impact of urban green and blue spaces on human health and well-being is still required. Furthermore, all relevant policy fields need to develop awareness of the importance of green and blue spaces for quality of life and health, so that the issue of health is taken into consideration adequately as well as in a socially sensitive manner in urban decision processes.

Exposure to urban nanoparticles at low PM[Formula: see text] concentrations as a source of oxidative stress and inflammation

Exposures to fine particulate matter (PM[Formula: see text]) have been associated with health impacts, but the understanding of the PM[Formula: see text] concentration-response (PM[Formula: see text]-CR) relationships, especially at low PM[Formula: see text], remains incomplete. Here, we present novel data using a methodology to mimic lung exposure to ambient air (2[Formula: see text] 60 [Formula: see text]g m[Formula: see text]), with minimized sampling artifacts for nanoparticles. A reference model (Air Liquid Interface cultures of human bronchial epithelial cells, BEAS-2B) was used for aerosol exposure. Non-linearities observed in PM[Formula: see text]-CR curves are interpreted as a result of the interplay between the aerosol total oxidative potential (OP[Formula: see text]) and its distribution across particle size (d[Formula: see text]). A d[Formula: see text]-dependent condensation sink (CS) is assessed together with the distribution with d[Formula: see text] of reactive species . Urban ambient aerosol high in OP[Formula: see text], as indicated by the DTT assay, with (possibly copper-containing) nanoparticles, shows higher pro-inflammatory and oxidative responses, this occurring at lower PM[Formula: see text] concentrations (< 5 [Formula: see text]g m[Formula: see text]). Among the implications of this work, there are recommendations for global efforts to go toward the refinement of actual air quality standards with metrics considering the distribution of OP[Formula: see text] with d[Formula: see text] also at relatively low PM[Formula: see text].

Measuring Nurses' Knowledge and Awareness of Climate Change and Climate-Associated Diseases: Protocol for a Systematic Review of Existing Instruments

BACKGROUND

Climate change is a health emergency. Each year, it is estimated to cost more than 230 million years of life expectancy, with 4-9 million premature deaths associated with air pollution, and 9 million excess deaths due to non-optimal temperatures, representing 7% more temperature-related deaths since 2015 and 66% more since 2000.

OBJECTIVE

Identify and evaluate the reliability, fidelity, and validity of instruments measuring nurses' knowledge and awareness of climate change and climate-associated diseases.

METHODS

A systematic literature review will retrieve and assess studies examining instruments measuring nurses' knowledge and awareness of climate change and climate-associated diseases. Using predefined search terms for nurses, climate change, literacy and scales or tools, we will search for published articles recorded in the following electronic databases, with no language or date restrictions, from their inception until 31 October 2023: Medline Ovid SP (from 1946), PubMed (NOT Medline[sb], from 1996), Embase.com (from 1947), CINAHL Ebesco (from 1937), the Cochrane Library Wiley (from 1992), Web of Science Core Collection (from 1900), the Trip Database (from 1997), JBI OVID SP (from 1998), and the GreenFILE EBSCO. We will also hand-search relevant articles' bibliographies and search for unpublished studies using Google Scholar, ProQuest Dissertations and Theses Global, and DART-EUrope.eu. This will be completed by exploring the gray literature in OpenGrey and the Grey Literature Report, from inception until 31 October 2023, in collaboration with a librarian. Twelve bibliographic databases will be searched for publications up to 31 October 2023. The papers selected will be assessed for their quality.

RESULTS

The electronic database searches were completed in May 2023. Retrieved articles are being screened, and the study will be completed by October 2023. After removing duplicates, our search strategy has retrieved 3449 references.

CONCLUSIONS

This systematic review will provide specific knowledge about instruments to measure nurses' knowledge, awareness, motivation, attitudes, behaviors, beliefs, skills, and competencies regarding climate change and climate-associated diseases.

The effect of an app-based dietary intervention on diet-related greenhouse gas emissions - results from a randomized controlled trial

BACKGROUND

Dietary change towards a diet low in greenhouse gas emissions (GHGEs) can reduce climate impact and improve individual-level health. However, there is a lack of understanding if diet interventions can achieve low-GHGE diets.

METHODS

A randomized controlled trial was conducted to assess the effects of an app-based intervention. The intervention was designed to improve dietary intake of people with Type 2 diabetes, and was delivered via an app over 12 weeks, with each week covering one diet-related topic. Dietary intake was assessed at baseline and 3-month follow up by a 95-item food frequency questionnaire and linked to GHGE values. A total of n = 93 participants (n = 46 and n = 47 for the intervention and control group, respectively) were included in the analysis. Changes to GHGEs within and between the groups were analysed with inferential statistics.

RESULTS

The majority (60%) of participants were male, with a mean age of 63.2 years and body mass index of 30 kg/m2. At baseline, diet-related GHGEs were 4.8 and 4.9 kg CO2-eq/day in the intervention and control group, respectively. At 3-month follow up the corresponding GHGEs were 4.7 and 4.9 kg CO2-eq/day. We found no statistically significant changes to diet-related GHGEs within or between groups, or within food categories, from baseline to 3-month follow up.

CONCLUSION

No evidence was found for the effectiveness of the app-based intervention to generate changes to diet-related GHGEs in a population of people with Type 2 diabetes. However, future interventions that target reducing meat consumption specifically may have the potential to result in a reduction of individual-level diet-related GHGEs.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03784612. Registered 24 December 2018. www.

CLINICALTRIALS

gov/ct2/show/NCT03784612 .

Perceptions, attitudes, awareness and perspectives towards sustainability practices and climate change among nurses: a systematic review protocol

INTRODUCTION

Climate change has been described as the most significant threat to humanity and human health to have emerged this century. It is widely accepted that contemporary human activities are the major causes of climate change. It is also acknowledged that damaging human activities could be amenable to change through proactive environmental behaviours. Healthcare professionals have the potential to promote climate advocacy and mitigation through collective effort and individual actions. However, research suggests that nurses may not be aware of their potential to effect positive action. This review will synthesise evidence regarding nurses' perceptions, attitudes, awareness and perspectives towards sustainable nursing practices and climate change.

METHODS AND ANALYSIS

The Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews will be applied to this proposed systematic review. It will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, PsycINFO, SCOPUS and PubMed databases will be searched. Data appraisal will be completed using the JBI and Mixed Methods Assessment Tool critical appraisal tool. Data synthesis and integration will follow the JBI convergent integrated approach.

ETHICS AND DISSEMINATION

In compliance with university ethics requirements for secondary research and postgraduate researchers, ethical approval will be sought from the Coventry University Ethics Committee, UK. Dissemination of findings will be achieved through peer-review publications, conference presentations and seminars with local, national and international audiences.

[The potential of nutrition for pain management and planetary health]

The consumption of western diets that are often rich in animal-source foods and low in wholesome, plant-based foods, has grave implications for public health. This is expressed in a growing prevalence of obesity as well as high rates of cardiovascular and metabolic diseases and some cancers. At the same time, current global dietary patterns are major contributors to global environmental challenges, i.e. the climate and the biodiversity crisis, and are thereby a major threat to planetary health. Shifting to more plant-based diets, e.g. in line with the "Planetary Health Diet", provides a major opportunity to improve individual and planetary health. Plant-based dietary patterns with an increase in the consumption of anti-inflammatory and a decrease in pro-inflammatory substances can also lead to improvements in pain symptoms, especially in inflammatory or degenerative joint diseases. In addition, dietary shifts are a prerequisite to achieve global environmental targets and thereby ensure a livable and healthy future for everyone. Medical professionals therefore have a special responsibility to actively promote this transformation.

An EAACI review: Go green in health care and research. Practical suggestions for sustainability in clinical practice, laboratories, and scientific meetings

Health care professionals (HCPs) and researchers in the health care sector dedicate their professional life to maintaining and optimizing the health of their patients. To achieve this, significant amounts of resources are used and currently it is estimated that the health care sector contributes to more than 4% of net greenhouse gas (GHG) emissions. GHG emissions adversely impact planetary health and consequently human health, as the two are intricately linked. There are many factors of health care that contribute to these emissions. Hospitals and research labs also use high amounts of consumables which require large amounts of raw materials and energy to produce. They are further responsible for polluting the environment via disposal of plastics, drug products, and other chemicals. To maintain and develop state-of-the-art best practices and treatments, medical experts exchange and update their knowledge on methods and technologies in the respective fields at highly specialized scientific meetings. These meetings necessitate thousands of attendants traveling around the globe. Therefore, while the goal of HCPs is to care for the individual, current practices have an enormous (indirect) impact on the health of the patients by their negative environmental impacts. There is an urgent need for HCPs and researchers to mitigate these detrimental effects. The installation of a sustainability-manager at health care facilities and research organizations to implement sustainable practices while still providing quality health care is desirable. Increased use of telemedicine, virtual/hybrid conferences and green chemistry have recently been observed. The benefits of these practices need to be evaluated and implemented as appropriate. With this manuscript, we aim to increase the awareness about the negative impacts of the health care system (including health care research) on planetary and human health. We suggest some easy and highly impactful steps and encourage health care professionals and research scientists of all hierarchical levels to immediately implement them in their professional as well as private life to counteract the health care sector's detrimental effects on the environment.

Education in the Anthropocene: assessing planetary health science standards in the USA

The environmental crises defining the Anthropocene demand ubiquitous mitigation efforts, met with collective support. Yet, disengagement and disbelief surrounding planetary health threats are pervasive, especially in the USA. This scepticism may be influenced by inadequate education addressing the scope and urgency of the planetary health crisis. We analysed current K-12 science standards related to planetary health throughout the USA, assessing their quality and potential predictors of variation. While planetary health education varies widely across the USA with respect to the presence and depth of terms, most science standards neglected to convey these concepts with a sense of urgency. Furthermore, state/territory dominant political party and primary gross domestic product (GDP) contributor were each predictive of the quality of planetary health education. We propose that a nation-wide science standard could fully address the urgency of the planetary health crisis and prevent political bias from influencing the breadth and depth of concepts covered.

Zooplankton community turnover in response to a novel TiO2-coated nano-formulation of carbendazim and its constituents

Novel nanomaterial-based pesticide formulations are increasingly perceived as promising aids in the transition to more efficient agricultural production systems. The current understanding of potential unintended (eco)toxicological impacts of nano-formulated pesticides is scarce, in particular with regard to (non-target) aquatic organisms and ecosystems. The present study reports the results of a long-term freshwater mesocosm experiment which assessed responses of individual zooplankton taxa and communities to a novel TiO2-coated nano-formulation of the fungicide carbendazim. Population- and community trends were assessed and compared in response to the nano-formulation and its constituents applied individually (i.e. nano-sized TiO2, carbendazim) and in combination (i.e. nano-sized TiO2 & carbendazim). Minimal differences were observed between effects induced by the nano-formulation and its active ingredient (i.e. carbendazim) when applied at equivalent nominal test concentrations (4 μg L-1). Nano-sized TiO2 was found to affect zooplankton community trends when applied separately at environmentally realistic concentrations (20 μg L-1 nominal test concentration). However, when nano-sized TiO2 was applied in combination with carbendazim, nano-sized TiO2 was found not to alter effects on community trends induced by carbendazim. The findings of the current study provide an extensive and timely addition to the current body of work available on non-target impacts of nano-formulated pesticides.

The ecological footprint of physicians: A survey of physicians in Canada, India, and USA

Combating climate change may be the greatest public health opportunity of the 21st century. While physicians play an important role in addressing climate change, given their affluence in society, they may be an important source of greenhouse gas emissions themselves. We sought to examine the size and nature of the ecological footprint of physicians and medical students. We conducted an online survey from December 2021-May 2022 examining resource consumption, changes in consumption patterns over time, and beliefs about climate change. Participants were medical students, residents, and staff physicians in Canada, India, or USA. Only 20 out of 162 valid respondents had a low ecological footprint (12%), defined as meat intake ≤2 times per week, living in an apartment or condominium, and using public transport, bicycle, motorcycle or walking to work. 14 of these 20 participants were from India. 91% of participants were open to reducing their own ecological footprint, though only 40% had made changes in that regard. 49% participants who discussed climate change at work and at home had decreased their ecological footprint, compared to 29% of participants who rarely engaged in such conversations (OR 2.39, 95% CI 1.24-4.63, P = 0.01). We conclude that physicians have a large ecological footprint, especially those from Canada and USA. A majority of physicians are interested in reducing their ecological footprint, and those who engage in conversations around climate change are more likely to have done so. Talking frequently about climate change, at work and at home, will likely increase climate change action amongst physicians.

Perseverance, partnerships and passion: ingredients for successful local government policy to promote healthy and sustainable diets

BACKGROUND

Local government authorities are well-placed to invest in evidence-based food policies that promote a population-wide shift to healthy and sustainable diets. This study describes the contextual factors that facilitated or impeded policy-making related to healthy and sustainable diets within a 'best-performing' local government in Victoria, Australia.

METHODS

Guided by the Consolidated Framework for Implementation Research (CFIR), data from semi-structured interviews with individuals involved in developing the City of Greater Bendigo's Food System Strategy were analysed using the seven-stage Framework Method.

RESULTS

Semi-structured interviews (n = 24) were conducted with City of Greater Bendigo employees (n = 15) and key stakeholders working for local organisations (n = 6) or at a state or national level (n = 3). Interviewees mostly held positions of leadership (n = 20) and represented diverse areas of focus from health (n = 7), food systems (n = 4) and planning and public policy (n = 3). Data analysis revealed 12 cross-cutting themes; eight facilitating factors and four impeding factors. Facilitating factors included perseverance, community engagement, supportive state policy, effective leadership, a global platform and networks, partnerships, workforce capacity and passion, and the use of scientific evidence. Impeding factors included access to secure, ongoing financial resources, prohibitive state and federal policy, COVID-related disruptions to community engagement and competing stakeholder interests. Overall, this study suggests that the City of Greater Bendigo's success in developing an evidence-based local food system policy is built upon (i) a holistic worldview that embraces systems-thinking and credible frameworks, (ii) a sustained commitment and investment throughout the inner-setting over time, and (iii) the ability to establish and nurture meaningful partnerships with community groups, neighbouring local government areas and state-level stakeholders, built upon values of reciprocity and respect.

CONCLUSIONS

Despite insufficient resourcing and prohibitive policy at higher levels of government, this 'best performing' local government in Victoria, Australia developed an evidence-based food system policy by employing highly skilled and passionate employees, embracing a holistic worldview towards planetary health and harnessing global networks. Local government authorities aspiring to develop integrated food policy should nurture a workforce culture of taking bold evidence-informed policy action, invest in mechanisms to enable long-standing partnerships with community stakeholders and be prepared to endure a 'slow-burn' approach.

The I-frame vs. S-frame: how neoliberalism has led behavioral sciences astray

In their recently published paper, Chater and Loewenstein critically elaborate on the differences between interventions that focus on individual behavior ('i-frame'), as opposed to the systems in which health behavior occurs ('s-frame'). They point out that behavioral scientists frequently rely on individual-level interventions, rather than systemic change to improve population health. As individual-level interventions have fallen short of the author's expectations to fix health problems, the authors argue that behavioral scientists should focus more on system-level change. They warn behavioral scientists that by framing disease as an individual problem they hinder real change. We agree with the arguments made by the authors; nevertheless, we propose that bringing underlying causes for the i-frame focus to light would advance their argument. In our commentary, we discuss that neoliberalism might be a reason for the focus on individual interventions in behavioral health sciences.

The negative impact of vegetarian and vegan labels: Results from randomized controlled experiments with US consumers

Reducing consumption of animal products is a critically important challenge in efforts to mitigate the climate crisis. Despite this, meals containing animal products are often presented as the default versus more environmentally sustainable vegetarian or vegan options. We tested whether vegetarian and vegan labels on menu items negatively impact the likelihood of US consumers choosing these items by using a between-subjects experimental design, where participants chose a preference between two items. Menu items were presented with titles and descriptions typical at restaurants, and a random group saw "vegan" or "vegetarian" labels in the titles of one of the two items. Two field studies were conducted at a US academic institution, where people selected what to eat via event registration forms. The methodology was extended to an online study, where US consumers selected what to hypothetically eat in a series of choice questions. Overall, results showed the menu items were significantly less likely to be chosen when they were labeled, with much larger effects in the field studies, where choice was not hypothetical. In addition, the online study showed male participants had a significantly higher preference for options containing meat versus other participants. Results did not indicate the impact of labels differed by gender. Furthermore, this study did not find that vegetarians and vegans were more likely to choose items with meat when the labels were removed, indicating that removing labels did not negatively impact them. The results suggest removing vegetarian and vegan labels from menus could help guide US consumers towards reduced consumption of animal products.

Dietary environmental impacts of French adults are poorly related to their income levels or food insecurity status

PURPOSE

Recent global-scale analysis showed the extent of inequality in terms of carbon emissions related to overall consumption, with richer households emitting significantly more greenhouse gases than poorer ones. While socio-economic status is a known determinant of food consumption, and despite the urgent need to move towards more sustainable diets, very few studies have explored socio-economic differences regarding the environmental impacts of diets. The objective of the present study was to compare the environmental impacts of French adults' diets according to food insecurity (FI) status and income level.

METHODS

The environmental impacts of diets of a representative sample of adults living in France (n = 1964) were assessed using data from the last National Individual Food Consumption Survey (INCA3) and the Agribalyse® v3.0.1 environmental database. Fifteen impact indicators were estimated, including climate change, eutrophication (freshwater, marine, terrestrial), resource depletion (energy, minerals, water), and the single EF score. First, the mean diet-related impact (per day per person) was estimated for each environmental indicator by decile of environmental impact. Second, the environmental impacts of diets of individuals living in food-insecure households (severe and moderate FI, as measured by the Household Food Security Survey Module) were compared with those of individuals living in food-secure households, the latter being divided by income decile. Differences in environmental impacts of diets (total and by food group) between these 12 sub-populations were tested by ANOVA after adjustment for age, gender, energy intake and household size.

RESULTS

The 10% of the population with the highest environmental impact has a mean impact approximately 3-6 times higher than the 10th with the lowest environmental impact, depending on the indicator. Individuals living in households with severe and moderate FI represented 3.7% and 6.7% of the studied population, respectively. Results showed a high variability in impacts within each of the 12 sub-population and no difference in environmental impacts of diets between sub-populations, except for water use (p < 0.001) and freshwater eutrophication (p = 0.02). The lowest water use and freshwater eutrophication were observed for individuals living in households with severe FI and the highest for high-income sub-populations, with differences mainly explained by the level of fruit and vegetable intakes and the type of fish consumed, respectively. Low-income populations, in particular individuals living in households with severe FI, had relatively high intakes of ruminant meat but for most indicators, the high environmental impact of this food group was offset by low consumption of other high impacting food groups (e.g., fruits and vegetables), and/or by high consumption of low impacting food groups (e.g., starches), resulting in no difference in the impact at the diet level.

CONCLUSION

While there is a high inter-individual variability in the environmental impacts of diets, this variability was not related to income level or FI status for most indicators, except higher water use and freshwater eutrophication in higher-income populations. Overall, our results underline the importance of considering individual dietary patterns and thinking at the whole diet level, and not only considering specific food or food groups impacts, when designing educational tools or public policies to promote more sustainable diets.

Harnessing human and machine intelligence for planetary-level climate action

The ongoing global race for bigger and better artificial intelligence (AI) systems is expected to have a profound societal and environmental impact by altering job markets, disrupting business models, and enabling new governance and societal welfare structures that can affect global consensus for climate action pathways. However, the current AI systems are trained on biased datasets that could destabilize political agencies impacting climate change mitigation and adaptation decisions and compromise social stability, potentially leading to societal tipping events. Thus, the appropriate design of a less biased AI system that reflects both direct and indirect effects on societies and planetary challenges is a question of paramount importance. In this paper, we tackle the question of data-centric knowledge generation for climate action in ways that minimize biased AI. We argue for the need to co-align a less biased AI with an epistemic web on planetary health challenges for more trustworthy decision-making. A human-in-the-loop AI can be designed to align with three goals. First, it can contribute to a planetary epistemic web that supports climate action. Second, it can directly enable mitigation and adaptation interventions through knowledge of social tipping elements. Finally, it can reduce the data injustices associated with AI pretraining datasets.

Post-growth economics: a must for planetary health justice

Within the global health field, progress is being made to adopt a justice and sustainability-centred approach by advancing what has been named a planetary health agenda. Meanwhile, an increasing number of global health scholars argue for the decolonisation of the field. Yet, amongst these collective efforts to 'transform' global health thinking, a thorough analysis of political economy dimensions is often missing. 'Growthism', the belief that more production is necessarily good, continues to prevail. Truly committing to a decolonial eco-just global health agenda requires addressing the continuation of colonial arrangements within the structure of the global economy, removing growth dependencies and ushering in post-growth policies.

Real-time genomics for One Health

The ongoing degradation of natural systems and other environmental changes has put our society at a crossroad with respect to our future relationship with our planet. While the concept of One Health describes how human health is inextricably linked with environmental health, many of these complex interdependencies are still not well-understood. Here, we describe how the advent of real-time genomic analyses can benefit One Health and how it can enable timely, in-depth ecosystem health assessments. We introduce nanopore sequencing as the only disruptive technology that currently allows for real-time genomic analyses and that is already being used worldwide to improve the accessibility and versatility of genomic sequencing. We showcase real-time genomic studies on zoonotic disease, food security, environmental microbiome, emerging pathogens, and their antimicrobial resistances, and on environmental health itself - from genomic resource creation for wildlife conservation to the monitoring of biodiversity, invasive species, and wildlife trafficking. We stress why equitable access to real-time genomics in the context of One Health will be paramount and discuss related practical, legal, and ethical limitations.

Commercial lobbying and political contributions: an Australian scoping review

OBJECTIVE

Many of the most effective and equitable policies to reduce the burden of non-communicable diseases threaten the interests of powerful corporations. A first step for public health advocates seeking to challenge powerful corporate interests is to understand the nature and extent of corporate political practices. This scoping review explored public health research on two political practices in Australia: lobbying and political donations.

METHODS

We searched six databases, two Google Advanced searches and 11 Australian public health websites. We screened 2866 documents in total, and extracted information about political practices, industry actors and datasets.

RESULTS

62 studies published between 1980 and 2021 were identified, analysing public health advocacy, policy submissions, direct engagement with government representatives and political donations. We extracted data from 14 studies that focused on direct engagement and/or political donations. Most focused on 'unhealthy commodity industries.'

CONCLUSIONS

Analysis of lobbying and political contributions in Australia is a nascent but expanding area of public health research. We discuss opportunities for future research to strengthen the evidence base and support public health advocacy to counter harmful corporate practices and promote and protect population health.

IMPLICATIONS FOR PUBLIC HEALTH

Countering powerful commercial interests requires greater investment in understanding corporate political activities.