Climate change: challenges and opportunities for global health

Big Data Sensors of Organic Advocacy: The Case of Leonardo DiCaprio and Climate Change

The strategies that experts have used to share information about social causes have historically been top-down, meaning the most influential messages are believed to come from planned events and campaigns. However, more people are independently engaging with social causes today than ever before, in part because online platforms allow them to instantaneously seek, create, and share information. In some cases this “organic advocacy” may rival or even eclipse top-down strategies. Big data analytics make it possible to rapidly detect public engagement with social causes by analyzing the same platforms from which organic advocacy spreads. To demonstrate this claim we evaluated how Leonardo DiCaprio’s 2016 Oscar acceptance speech citing climate change motivated global English language news (Bloomberg Terminal news archives), social media (Twitter postings) and information seeking (Google searches) about climate change. Despite an insignificant increase in traditional news coverage (54%; 95%CI: -144 to 247), tweets including the terms “climate change” or “global warming” reached record highs, increasing 636% (95%CI: 573–699) with more than 250,000 tweets the day DiCaprio spoke. In practical terms the “DiCaprio effect” surpassed the daily average effect of the 2015 Conference of the Parties (COP) and the Earth Day effect by a factor of 3.2 and 5.3, respectively. At the same time, Google searches for “climate change” or “global warming” increased 261% (95%CI, 186–335) and 210% (95%CI 149–272) the day DiCaprio spoke and remained higher for 4 more days, representing 104,190 and 216,490 searches. This increase was 3.8 and 4.3 times larger than the increases observed during COP’s daily average or on Earth Day. Searches were closely linked to content from Dicaprio’s speech (e.g., “hottest year”), as unmentioned content did not have search increases (e.g., “electric car”). Because these data are freely available in real time our analytical strategy provides substantial lead time for experts to detect and participate in organic advocacy while an issue is salient. Our study demonstrates new opportunities to detect and aid agents of change and advances our understanding of communication in the 21st century media landscape.

Climate Change and Its Impact on the Incarcerated Population: A Descriptive Review

This descriptive review article describes climate change and its detrimental effects on incarcerated populations. Case examples are provided of specific natural disasters and deaths due to overheating temperatures. Because public health and social work aims to improve the health and social welfare of vulnerable populations, the authors explain why climate change should be considered a priority area in both fields. Examples are provided on how to improve conditions for the 2.4 million men, women, and youth who are incarcerated.

Health in climate change research from 1990 to 2014: positive trend, but still underperforming

Background

Climate change has been recognized as both one of the biggest threats and the biggest opportunities for global health in the 21st century. This trend review seeks to assess and characterize the amount and type of scientific literature on the link between climate change and human health.

Design

We tracked the use of climate-related terms and their co-occurrence with health terms during the 25 years since the first Intergovernmental Panel on Climate Change (IPCC) report, from 1990 to 2014, in two scientific databases and in the IPCC reports. We investigated the trends in the number of publications about health and climate change through time, by nature of the health impact under study, and by geographic area. We compared the scientific production in the health field with that of other sectors on which climate change has an impact.

Results

The number of publications was extremely low in both databases from 1990 (325 and 1,004, respectively) until around 2006 (1,332 and 4,319, respectively), which has since then increased exponentially in recent years (6,079 and 17,395, respectively, in 2014). However, the number of climate change papers regarding health is still about half that of other sectors. Certain health impacts, particularly malnutrition and non-communicable diseases (NCDs), remain substantially understudied. Approximately two-thirds of all published studies were carried out in OECD countries (Organization for Economic Cooperation and Development), predominantly in Europe and North America.

Conclusions

There is a clear need for further research on the links between climate change and health. This pertains particularly to research in and by those countries in which health will be mostly affected and capacity to adapt is least. Specific undertreated topics such as NCDs, malnutrition, and mental health should gain the priority they deserve. Funding agencies are invited to take note of and establish calls for proposals accordingly. Raising the interest in this research area in young scientists remains a challenge and should lead to innovative courses for large audiences, such as Massive Open Online Courses.

Untangling the Impacts of Climate Change on Waterborne Diseases: a Systematic Review of Relationships between Diarrheal Diseases and Temperature, Rainfall, Flooding, and Drought

Global climate change is expected to affect waterborne enteric diseases, yet to date there has been no comprehensive, systematic review of the epidemiological literature examining the relationship between meteorological conditions and diarrheal diseases. We searched PubMed, Embase, Web of Science, and the Cochrane Collection for studies describing the relationship between diarrheal diseases and four meteorological conditions that are expected to increase with climate change: ambient temperature, heavy rainfall, drought, and flooding. We synthesized key areas of agreement and evaluated the biological plausibility of these findings, drawing from a diverse, multidisciplinary evidence base. We identified 141 articles that met our inclusion criteria. Key areas of agreement include a positive association between ambient temperature and diarrheal diseases, with the exception of viral diarrhea and an increase in diarrheal disease following heavy rainfall and flooding events. Insufficient evidence was available to evaluate the effects of drought on diarrhea. There is evidence to support the biological plausibility of these associations, but publication bias is an ongoing concern. Future research evaluating whether interventions, such as improved water and sanitation access, modify risk would further our understanding of the potential impacts of climate change on diarrheal diseases and aid in the prioritization of adaptation measures.

Rapid assessment of disaster damage using social media activity

Could social media data aid in disaster response and damage assessment? Countries face both an increasing frequency and an increasing intensity of natural disasters resulting from climate change. During such events, citizens turn to social media platforms for disaster-related communication and information. Social media improves situational awareness, facilitates dissemination of emergency information, enables early warning systems, and helps coordinate relief efforts. In addition, the spatiotemporal distribution of disaster-related messages helps with the real-time monitoring and assessment of the disaster itself. We present a multiscale analysis of Twitter activity before, during, and after Hurricane Sandy. We examine the online response of 50 metropolitan areas of the United States and find a strong relationship between proximity to Sandy's path and hurricane-related social media activity. We show that real and perceived threats, together with physical disaster effects, are directly observable through the intensity and composition of Twitter's message stream. We demonstrate that per-capita Twitter activity strongly correlates with the per-capita economic damage inflicted by the hurricane. We verify our findings for a wide range of disasters and suggest that massive online social networks can be used for rapid assessment of damage caused by a large-scale disaster.

A multilevel analysis to explain self-reported adverse health effects and adaptation to urban heat: a cross-sectional survey in the deprived areas of 9 Canadian cities

Background

This study identifies the characteristics and perceptions related to the individual, the dwelling and the neighbourhood of residence associated with the prevalence of self-reported adverse health impacts and an adaptation index when it is very hot and humid in summer in the most disadvantaged sectors of the nine most populous cities of Québec, Canada, in 2011.

Methods

The study uses a cross-sectional design and a stratified representative sample; 3485 people (individual-level) were interviewed in their residence. They lived in 1647 buildings (building-level) in 87 most materially and socially disadvantaged census dissemination areas (DA-level). Multilevel analysis was used to perform 3-level models nested one in the other to examine individual impacts as well as the adaptation index.

Results

For the prevalence of impacts, which is 46 %, the logistic model includes 13 individual-level indicators (including air conditioning and the adaptation index) and 1 building-level indicator. For the adaptation index, with values ranging from -3 to +3, the linear model has 10 individual-level indicators, 1 building-level indicator and 2 DA-level indicators. Of all these indicators, 9 were associated to the prevalence of impacts only and 8 to the adaptation index only.

Conclusion

This 3-level analysis shows the differential importance of the characteristics of residents, buildings and their surroundings on self-reported adverse health impacts and on adaptation (other than air conditioning) under hot and humid summer conditions. It also identifies indicators specific to impacts or adaptation. People with negative health impacts from heat rely more on adaptation strategies while low physical activity and good dwelling/building insulation lead to lower adaptation. Better neighbourhood walkability favors adaptations other than air conditioning. Thus, adaptation to heat in these neighbourhoods seems reactive rather than preventive. These first multi-level insights pave the way for the development of a theoretical framework of the process from heat exposure to impacts and adaptation for research, surveillance and public health interventions at all relevant levels.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2749-y) contains supplementary material, which is available to authorized users.

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.

Mobile mental health interventions following war and disaster

Mobile technologies offer potentially critical ways of delivering mental health support to those experiencing war, ethnic conflict, and human-caused and natural disasters. Research on Internet interventions suggests that effective mobile mental health technologies can be developed, and there are early indications that they will be acceptable to war and disaster survivors, and prove capable of greatly increasing the reach of mental health services. Promising mhealth interventions include video teleconferencing, text messaging, and smartphone-based applications. In addition, a variety of social media platforms has been used during and immediately after disasters to increase agility in responding, and strengthen community and individual resilience. Globally, PTSD Coach has been downloaded over 243,000 times in 96 countries, and together with large-scale use of social media for communication during disasters, suggests the potential for reach of app technology. In addition to enabling improved self-management of post-trauma problems, mobile phone interventions can also enhance delivery of face-to-face care by mental health providers and increase the effectiveness of peer helpers and mutual aid organizations. More research is needed to establish the efficacy of mhealth interventions for those affected by war and disaster. Research should also focus on the identification of active elements and core processes of change, determination of effective ways of increasing adoption and engagement, and explore ways of combining the various capabilities of mobile technologies to maximize their impact.

The Health Impacts of Climate Change: A Continuing Medical Education Needs Assessment Framework

INTRODUCTION

As the health consequences of climate change (CC) will likely become more manifest in the future, family physicians have to be knowledgeable about these impacts and the ways in which they can affect their patients. The main aim of this study was to propose a competency framework and questionnaire used to conduct a needs analysis to identify and prioritize family physicians' real educational needs regarding the health impacts of CC.

METHODS

A mixed method combining a qualitative interview and a quantitative online questionnaire was used (n = 24 physicians). The interview assessed key beliefs related to participating in an online continuing medical education (eCME) activity on the health impacts of climate change, and the perception of the key factors or conditions required to ensure the family physicians' satisfaction with this eCME activity. The questionnaire assessed the current and desired levels of competency on five general training themes: general knowledge about CC; heat-related illnesses; CC, extreme weather events and modification of vector-borne and zoonotic diseases; CC, extreme weather events and modification of water-borne diseases; and mental health impacts of natural disasters.

RESULTS

Results revealed the need for improved medical education on climate change and health. Results also add to the literature by showing that a 3-hour eCME activity covering these topics would be useful and would allow family physicians to use this knowledge in their daily practice, notably through prevention and counseling.

DISCUSSION

Introducing a CME needs assessment framework and a generic instrument that reflects family physicians' needs regarding the health impacts of CC has the added advantage of standardizing the assessment procedure.

Global Climate Change and Children's Health

Rising global temperatures are causing major physical, chemical, and ecological changes in the planet. There is wide consensus among scientific organizations and climatologists that these broad effects, known as "climate change," are the result of contemporary human activity. Climate change poses threats to human health, safety, and security, and children are uniquely vulnerable to these threats. The effects of climate change on child health include: physical and psychological sequelae of weather disasters; increased heat stress; decreased air quality; altered disease patterns of some climate-sensitive infections; and food, water, and nutrient insecurity in vulnerable regions. The social foundations of children's mental and physical health are threatened by the specter of far-reaching effects of unchecked climate change, including community and global instability, mass migrations, and increased conflict. Given this knowledge, failure to take prompt, substantive action would be an act of injustice to all children. A paradigm shift in production and consumption of energy is both a necessity and an opportunity for major innovation, job creation, and significant, immediate associated health benefits. Pediatricians have a uniquely valuable role to play in the societal response to this global challenge.

Climate Change and Geoecology of South and Southeast Asia: An Introduction

Climate change is projected to impact human health in many ways including changes in water availability and quality, air quality and sanitation, availability and access to food and nutrition and transmission of vector-borne diseases. Environmental consequences of climate change, such as extreme heat waves, rising sea levels, changes in precipitation resulting in flooding and droughts, intense hurricanes (cyclones, typhoons) and degraded air quality, can affect directly and indirectly the physical, social and psychological health of humans. Climate change and human health have emerged as an important focus of research in the World Health Organization since 2008. However, the First International Conference on Health and Climate organised by the WHO in August 2014 in Geneva recognises the relevance of the impact of climate change on human health from a global-change and health perspective. This chapter also highlights policies of the United States, China and India towards GHG emission reduction and the successful climate agreement in Paris in December 2015.

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.

Global prevention and control of NCDs: Limitations of the standard approach

The five-target '25 × 25' strategy for tackling the emerging global epidemic of non-communicable diseases (NCDs) focuses on four diseases (CVD, diabetes, cancer, and chronic respiratory disease), four risk factors (tobacco, diet and physical activity, dietary salt, and alcohol), and one cardiovascular preventive drug treatment. The goal is to decrease mortality from NCDs by 25 per cent by the year 2025. The 'standard approach' to the '25 × 25' strategy has the benefit of simplicity, but also has major weaknesses. These include lack of recognition of: (i) the fundamental drivers of the NCD epidemic; (ii) the 'missing NCDs', which are major causes of morbidity; (iii) the 'missing causes' and the 'causes of the causes'; and (iv) the role of health care and the need for integration of interventions.

Malaria vectors in South America: current and future scenarios

BACKGROUND

Malaria remains a significant public health issue in South America. Future climate change may influence the distribution of the disease, which is dependent on the distribution of those Anopheles mosquitoes competent to transmit Plasmodium falciparum. Herein, predictive niche models of the habitat suitability for P. falciparum, the current primary vector Anopheles darlingi and nine other known and/or potential vector species of the Neotropical Albitarsis Complex, were used to document the current situation and project future scenarios under climate changes in South America in 2070.

METHODS

To build each ecological niche model, we employed topography, climate and biome, and the currently defined distribution of P. falciparum, An. darlingi and nine species comprising the Albitarsis Complex in South America. Current and future (i.e., 2070) distributions were forecast by projecting the fitted ecological niche model onto the current environmental situation and two scenarios of simulated climate change. Statistical analyses were performed between the parasite and each vector in both the present and future scenarios to address potential vector roles in the dynamics of malaria transmission.

RESULTS

Current distributions of malaria vector species were associated with that of P. falciparum, confirming their role in transmission, especially An. darlingi, An. marajoara and An. deaneorum. Projected climate changes included higher temperatures, lower water availability and biome modifications. Regardless of future scenarios considered, the geographic distribution of P. falciparum was exacerbated in 2070 South America, with the distribution of the pathogen covering 35-46% of the continent. As the current primary vector An. darlingi showed low tolerance for drier environments, the projected climate change would significantly reduce suitable habitat, impacting both its distribution and abundance. Conversely, climate generalist members of the Albitarsis Complex showed significant spatial and temporal expansion potential in 2070, and we conclude these species will become more important in the dynamics of malaria transmission in South America.

CONCLUSIONS

Our data suggest that climate and landscape effects will elevate the importance of members of the Albitarsis Complex in malaria transmission in South America in 2070, highlighting the need for further studies addressing the bionomics, ecology and behaviours of the species comprising the Albitarsis Complex.

A Survey of Registered Dietitians' Concern and Actions Regarding Climate Change in the United States

Dietary choices are a tool to reduce greenhouse gas emissions. While registered dietitians are on the front lines of food and nutrition recommendations, it is unclear how many are concerned with climate change and take action in practice in the United States. We explored concern about climate change among registered dietitians, and identified factors that may influence practice-related behaviors. Our study population included a random sample of all registered dietitians credentialed in the United States. Primary data were gathered using a cross-sectional survey. Of the 570 survey responses, 75% strongly agreed or agreed that climate change is an important issue while 34% strongly agreed or agreed that dietitians should play a major role in climate change mitigation strategies. Thirty-eight percent engaged in activities that promoted diet as a climate change mitigation strategy. Vegetarian (p = 0.002) and vegan dietitians (p = 0.007) were significantly more likely than non-vegetarian and non-vegan dietitians to engage in activities that promoted diet as a climate change mitigation strategy. Overall, concern for climate change among dietitians varied significantly by the region of the country in which the dietitian resided, and awareness that animal products are implicated in climate change. Registered dietitians in the United States are concerned with climate change. However, there is a discrepancy between concern and practice-based actions. These results suggest the need for educational and experiential opportunities connecting climate change mitigation to dietetics practice.

Estimating greenhouse gas emissions of European cities--modeling emissions with only one spatial and one socioeconomic variable

Substantive and concerted action is needed to mitigate climate change. However, international negotiations struggle to adopt ambitious legislation and to anticipate more climate-friendly developments. Thus, stronger actions are needed from other players. Cities, being greenhouse gas emission centers, play a key role in promoting the climate change mitigation movement by becoming hubs for smart and low-carbon lifestyles. In this context, a stronger linkage between greenhouse gas emissions and urban development and policy-making seems promising. Therefore, simple approaches are needed to objectively identify crucial emission drivers for deriving appropriate emission reduction strategies. In analyzing 44 European cities, the authors investigate possible socioeconomic and spatial determinants of urban greenhouse gas emissions. Multiple statistical analyses reveal that the average household size and the edge density of discontinuous dense urban fabric explain up to 86% of the total variance of greenhouse gas emissions of EU cities (when controlled for varying electricity carbon intensities). Finally, based on these findings, a multiple regression model is presented to determine greenhouse gas emissions. It is independently evaluated with ten further EU cities. The reliance on only two indicators shows that the model can be easily applied in addressing important greenhouse gas emission sources of European urbanites, when varying power generations are considered. This knowledge can help cities develop adequate climate change mitigation strategies and promote respective policies on the EU or the regional level. The results can further be used to derive first estimates of urban greenhouse gas emissions, if no other analyses are available.

A call for sustainable practice in occupational therapy

BACKGROUND

The ability of the earth to sustain health among humans and in the natural world is under threat from overpopulation, environmental degradation, and climate change. These global threats are anticipated to harm health and human occupation in many direct and indirect ways. Strategies are needed to mitigate the effects of these threats and to build individual and community capacities to foster resilience.

PURPOSE

This paper links issues of sustainability with occupational therapy philosophy and discusses how employing a sustainability lens with professional reasoning can help practitioners integrate sustainability into their practice.

KEY ISSUES

Human occupation is inseparable from the environments in which people live. Human occupation has caused the current environmental crisis, and targeted human action is required to safeguard future health and well-being.

IMPLICATIONS

Occupational therapists have an ethical obligation to use professional reasoning strategies that, taken collectively, can help to build a sustainable and resilient future.

Reproductive and Birth Outcomes in Haiti Before and After the 2010 Earthquake

OBJECTIVE

We aimed to examine the relationship between exposure to the 2010 Haiti earthquake and pregnancy wantedness, interpregnancy interval, and birth weight.

METHODS

From the nationally representative Haiti 2012 Demographic and Health Survey, information on "size of child at birth" (too small or not) was available for 7280 singleton births in the previous 5 years, whereas information on birth weight was available for 1607 births. Pregnancy wantedness, short (<1 year) interpregnancy interval, and maternal-reported birth weight were compared before and after the earthquake and by level of damage. Multiple logistic regression and linear regression analyses were conducted.

RESULTS

Post-earthquake births were less likely to be wanted and more likely to be born after a short interpregnancy interval. Earthquake exposure was associated with increased likelihood of a child being born too small: timing of birth (after earthquake vs. before earthquake, adjusted odds ratio [aOR]: 1.27, 95% confidence interval [CI]: 1.12-1.45), region (hardest-hit vs. rest of country; aOR: 1.43, 95% CI: 1.14- 1.80), and house damage (aOR: 1.27 95% CI: 1.02-1.58). Mean birth weight was 150 to 300 g lower in those exposed to the earthquake.

CONCLUSIONS

Experience with the earthquake was associated with worse reproductive and birth outcomes, which underscores the need to provide reproductive health services as part of relief efforts.

Air quality and climate connections

Multiple linkages connect air quality and climate change. Many air pollutant sources also emit carbon dioxide (CO2), the dominant anthropogenic greenhouse gas (GHG). The two main contributors to non-attainment of U.S. ambient air quality standards, ozone (O3) and particulate matter (PM), interact with radiation, forcing climate change. PM warms by absorbing sunlight (e.g., black carbon) or cools by scattering sunlight (e.g., sulfates) and interacts with clouds; these radiative and microphysical interactions can induce changes in precipitation and regional circulation patterns. Climate change is expected to degrade air quality in many polluted regions by changing air pollution meteorology (ventilation and dilution), precipitation and other removal processes, and by triggering some amplifying responses in atmospheric chemistry and in anthropogenic and natural sources. Together, these processes shape distributions and extreme episodes of O3 and PM. Global modeling indicates that as air pollution programs reduce SO2 to meet health and other air quality goals, near-term warming accelerates due to "unmasking" of warming induced by rising CO2. Air pollutant controls on CH4, a potent GHG and precursor to global O3 levels, and on sources with high black carbon (BC) to organic carbon (OC) ratios could offset near-term warming induced by SO2 emission reductions, while reducing global background O3 and regionally high levels of PM. Lowering peak warming requires decreasing atmospheric CO2, which for some source categories would also reduce co-emitted air pollutants or their precursors. Model projections for alternative climate and air quality scenarios indicate a wide range for U.S. surface O3 and fine PM, although regional projections may be confounded by interannual to decadal natural climate variability. Continued implementation of U.S. NOx emission controls guards against rising pollution levels triggered either by climate change or by global emission growth. Improved accuracy and trends in emission inventories are critical for accountability analyses of historical and projected air pollution and climate mitigation policies.

IMPLICATIONS

The expansion of U.S. air pollution policy to protect climate provides an opportunity for joint mitigation, with CH4 a prime target. BC reductions in developing nations would lower the global health burden, and for BC-rich sources (e.g., diesel) may lessen warming. Controls on these emissions could offset near-term warming induced by health-motivated reductions of sulfate (cooling). Wildfires, dust, and other natural PM and O3 sources may increase with climate warming, posing challenges to implementing and attaining air quality standards. Accountability analyses for recent and projected air pollution and climate control strategies should underpin estimated benefits and trade-offs of future policies.

Climate Change and Health: Transcending Silos to Find Solutions

BACKGROUND

Climate change has myriad implications for the health of humans, our ecosystems, and the ecological processes that sustain them. Projections of rising greenhouse gas emissions suggest increasing direct and indirect burden of infectious and noninfectious disease, effects on food and water security, and other societal disruptions. As the effects of climate change cannot be isolated from social and ecological determinants of disease that will mitigate or exacerbate forecasted health outcomes, multidisciplinary collaboration is critically needed.

OBJECTIVES

The aim of this article was to review the links between climate change and its upstream drivers (ie, processes leading to greenhouse gas emissions) and health outcomes, and identify existing opportunities to leverage more integrated global health and climate actions to prevent, prepare for, and respond to anthropogenic pressures.

METHODS

We conducted a literature review of current and projected health outcomes associated with climate change, drawing on findings and our collective expertise to review opportunities for adaptation and mitigation across disciplines.

FINDINGS

Health outcomes related to climate change affect a wide range of stakeholders, providing ready collaborative opportunities for interventions, which can be differentiated by addressing the upstream drivers leading to climate change or the downstream effects of climate change itself.

CONCLUSIONS

Although health professionals are challenged with risks from climate change and its drivers, the adverse health outcomes cannot be resolved by the public health community alone. A phase change in global health is needed to move from a passive responder in partnership with other societal sectors to drive innovative alternatives. It is essential for global health to step outside of its traditional boundaries to engage with other stakeholders to develop policy and practical solutions to mitigate disease burden of climate change and its drivers; this will also yield compound benefits that help address other health, environmental, and societal challenges.

Caribbean Heat Threatens Health, Well-being and the Future of Humanity

Climate change has substantial impacts on public health and safety, disease risks and the provision of health care, with the poor being particularly disadvantaged. Management of the associated health risks and changing health service requirements requires adequate responses at local levels. Health-care providers are central to these responses. While climate change raises ethical questions about its causes, impacts and social justice, medicine and bioethics typically focus on individual patients and research participants rather than these broader issues. We broaden this focus by examining awareness among health-care providers in the Caribbean region, where geographic and socioeconomic features pose particular vulnerabilities to climate change. In focus groups, Caribbean providers described rises in mosquito-borne, flood-related, heat-related, respiratory and mental illnesses, and attributed these to local impacts of climate change. Their discussions showed that the significance of these impacts differs in different Caribbean nations, raising policy and social justice questions. Bioethics and public health ethics are situated to frame, inform and initiate public and policy dialog about values and scientific evidence associated with climate change. We urge readers to initiate such dialog within their own institutions about the context-dependent nature of the burdens of climate change, and values and policies that permit it to worsen.

Big Events and Risks to Global Substance Using Populations: Unique Threats and Common Challenges

In this commentary, we review a set of "Big Events" from around the world that have adversely impacted substance using populations by first identifying common thematic areas between them, and then describing the unique challenges faced by the diverse and vulnerable populations impacted. The Big Events reviewed are multifaceted and complex in nature, and include the recent global financial crisis, economic and trade sanctions, political transition and its impact on ethnic minorities, colonialism and indigenous communities, and ecological disasters. All have led to immense trauma, displacement, and disruption to critical healthcare services/treatment for people who use drugs, populations who are left underserved in the midst of these crises. It is our hope that through this comparative assessment, global policymakers will proactively identify Big Events and prioritize the development of interventions and policy that meet the unique and immediate needs of substance using population in order to mitigate the significant negative short- and long-term impacts on global public health.

Reducing the carbon footprint of hospital-based care

Climate change, driven by man-made greenhouse gas emissions, is a major threat to the health of this and future generations. Hospital-based healthcare generates large quantities of greenhouse gas emissions. Reducing the carbon footprint of healthcare requires direct action to reduce waste and energy use, but also requires radical reform of care pathways so that the only patients who come to or stay in hospital are people whose healthcare cannot safely be delivered closer to home. Achieving these reforms without major structural changes to the financial flows in the NHS will be extraordinarily difficult.

Human health impacts of climate change: implications for the practice and law of public health

Reducing greenhouse gas emissions is an urgent priority. While few would argue that action to mitigate the causes of climate change should be led by public health practitioners, public health has a critical role in adaptation efforts. Adaptation seeks to lessen human vulnerability to extreme weather and to increased variability in temperature and precipitation. Climate change as an emerging health issue provides a test case for new approaches to public health: approaches that emphasize both collaboration with other government and private entities and application of innovative legal strategies.

Climate change, human health, and epidemiological transition

The health of populations depends on the availability of clean air, water, food, and sanitation, exposure to pathogens, toxins and environmental hazards, and numerous genetic, behavioral and social factors. For many thousands of years, human life expectancy was low, and population growth was slow. The development of technology-based civilizations facilitated what Abdel Omran called "epidemiological transition," with increasing life expectancy and rapid population growth. To a large extent, the spectacular growth of human populations during the past two centuries was made possible by the energy extracted from fossil fuels. We have now learned, however, that greenhouse gases from fossil fuel combustion are warming the planet's surface, causing changes in oceanic and atmospheric systems, and disrupting weather and hydrological patterns. Climate change poses unprecedented threats to human health by impacts on food and water security, heat waves and droughts, violent storms, infectious disease, and rising sea levels. Whether or not humanity can reduce greenhouse gas emissions quickly enough to slow climate change to a rate that will allow societies to successfully adapt is not yet known. This essay reviews the current state of relevant knowledge, and points in a few directions that those interested in human health may wish to consider.

Cause-specific risk of hospital admission related to extreme heat in older adults

IMPORTANCE

Heat exposure is known to have a complex set of physiological effects on multiple organ systems, but current understanding of the health effects is mostly based on studies investigating a small number of prespecified health outcomes such as cardiovascular and respiratory diseases.

OBJECTIVES

To identify possible causes of hospital admissions during extreme heat events and to estimate their risks using historical data.

DESIGN, SETTING, AND POPULATION

Matched analysis of time series data describing daily hospital admissions of Medicare enrollees (23.7 million fee-for-service beneficiaries [aged ≥65 years] per year; 85% of all Medicare enrollees) for the period 1999 to 2010 in 1943 counties in the United States with at least 5 summers of near-complete (>95%) daily temperature data.

EXPOSURES

Heat wave periods, defined as 2 or more consecutive days with temperatures exceeding the 99th percentile of county-specific daily temperatures, matched to non-heat wave periods by county and week.

MAIN OUTCOMES AND MEASURES

Daily cause-specific hospitalization rates by principal discharge diagnosis codes, grouped into 283 disease categories using a validated approach.

RESULTS

Risks of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke were statistically significantly higher on heat wave days relative to matched non-heat wave days, but risk of hospitalization for congestive heart failure was lower (P < .05). Relative risks for these disease groups were 1.18 (95% CI, 1.12-1.25) for fluid and electrolyte disorders, 1.14 (95% CI, 1.06-1.23) for renal failure, 1.10 (95% CI, 1.04-1.16) for urinary tract infections, 1.06 (95% CI, 1.00-1.11) for septicemia, and 2.54 (95% CI, 2.14-3.01) for heat stroke. Absolute risk differences were 0.34 (95% CI, 0.22-0.46) excess admissions per 100,000 individuals at risk for fluid and electrolyte disorders, 0.25 (95% CI, 0.12-0.39) for renal failure, 0.24 (95% CI, 0.09-0.39) for urinary tract infections, 0.21 (95% CI, 0.01-0.41) for septicemia, and 0.16 (95% CI, 0.10-0.22) for heat stroke. For fluid and electrolyte disorders and heat stroke, the risk of hospitalization increased during more intense and longer-lasting heat wave periods (P < .05). Risks were generally highest on the heat wave day but remained elevated for up to 5 subsequent days.

CONCLUSIONS AND RELEVANCE

Among older adults, periods of extreme heat were associated with increased risk of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke. However, the absolute risk increase was small and of uncertain clinical importance.