The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come

Introducing new nurse leadership roles through an educational framework to protect the planet and human health

AIMS AND OBJECTIVES

This discussion paper proposes four new nursing leadership roles to address planetary health challenges.

BACKGROUND

Nurses are essential in reducing healthcare's greenhouse emissions. The Planetary Health Education Framework (PHEF) supports integrating planetary health concepts into sustainable healthcare practice. Nurse educators with planetary health expertise should teach the PHEF, while nurse climate advocates promote it to health professionals, with nurse-led planetary health researchers undertaking climate-change research and Planetary Health Nurse Practitioners practicing sustainable healthcare.

DESIGN

Discussion paper.

DATA SOURCES

A PICO framework was used to identify relevant articles: In nursing (P) should new roles be introduced (I) compared to no new roles (C) to understand climate change impacts on both nursing and planetary health (O).

DISCUSSION

Barriers to sustainable healthcare include denial, group-think, and ignorance. National and International organisation enablers highlight the importance of climate change in nurse education. The Australian College of Nursing recommends government funding for nurse-led planetary health research.

CONCLUSION

Educators should focus on curricula development, nurse climate advocates on education and policy, researchers on supporting planetary health research, and PHNPs on climate justice, environmental protection, and emissions reduction.

The role of the public health service in the implementation of heat health action plans for climate change adaptation in Germany: A qualitative study

BACKGROUND

In response to climate change-induced increases in heat periods, the WHO recommends the implementation of heat health action plans (HHAPs). In Germany, HHAPs are implemented neither comprehensively nor nationwide. Several recommendations have identified the public health service (PHS) at municipal and federal state levels as a key actor regarding to heat and health. Therefore, this study aimed at assessing the role of the PHS in implementing HHAPs at municipal and federal state levels in Germany.

METHODS

We conducted a policy document analysis to assess the legal basis for the work of the PHS in the 16 federal states in Germany. Furthermore, we conducted semi-structured interviews with 16 experts from within and outside the PHS to explore their perceptions of the PHS in the implementation of HHAPs. The interviews were analysed using reflective thematic analysis.

RESULTS

The policy document analysis revealed that heat is not mentioned in any of the federal states' regulatory frameworks for the PHS, while tasks related to environment and health are addressed, but tend to remain vague. The interviews confirmed that there is currently no clearly defined role for the PHS in implementing HHAPs in Germany and that the actual role primarily depends on the local setting. Main barriers and facilitators could be assigned to three levels (individual, organizational and political), and two overarching contextual factors (awareness of the need for adaptation and existence of other public health emergencies) influenced the implementation of HHAPs across all levels. At the individual level, motivation, knowledge and competencies, and previous experience were possible barriers or enablers. At the organizational level, administrative structures, financial and human resources, leadership and networks were barriers or facilitators, while at the political level they included legislation and political decisions.

CONCLUSIONS

The PHS could and should be a relevant actor for implementing measures addressing health and climate change locally, in particular because of its focus on vulnerable populations. However, our findings suggest that the legal basis in the federal states of Germany is insufficient. Tailored approaches are needed to overcome barriers such as rigid, non-agile administrative structures and competing priorities, while taking advantage of facilitators such as awareness of relevant actors.

The interaction effects between summer heat exposure and economic development on the settlement intention in floating population in China

Limited studies examined the interaction effects between summer heat exposure and economic development on the settlement intention, especially for the floating population. Binary logistic regression model was used to examine the association of summer temperature, per capita GRDP (PGRDP), summer temperature × PGRDP with settlement intention. Additive interaction term for summer temperature and PGRDP level was used to test the interactive effects. This study indicates that summer heat exposure will decrease the settlement intention of migrants (OR:1.386, 95% CI: 1.35-1.423), while PGRDP will increase settlement intention (OR: 0.893, 95% CI: 0.870-0.917). There is a negative interaction between summer temperature and PGRDP in the additive model. To a certain extent, summer heat exposure can weaken the attractiveness of economic development for migrants to settle down, they prefer to settle in cities with favorable temperatures and high levels of economic development. Stratified analyses illustrated that summer heat exposure showed lower settlement intention among female, the elderly, engaged in agriculture and industry and living in central China. The government should take measures about mitigation, adaptation and balancing economic development and climate change to reduce the adverse impacts of summer heat, and pay more attention to vulnerable groups and backward regions.

Inverse Trend Between Tree Pollen and Fungal Concentrations With Allergic Sensitization Rates in Seoul for 25 Years

A growing number of individuals are developing allergic diseases due to pollen exposure. Seasonal variations and increased pollen concentrations have occurred with the increased rates of allergic sensitization among both children and adults. Temperature significantly influences pollination, particularly in spring- and early summer-flowering plants, with weather conditions affecting pollen allergen levels. Human activities, including agriculture and deforestation, increase carbon emissions, leading to higher atmospheric CO₂ levels that may enhance allergenic plant productivity. Climate change affects the range of allergenic plant species and length of pollen season. Studies indicate that higher CO₂ and temperature levels are linked to increased pollen concentrations and allergenicity, whereas atmospheric fungal concentrations have declined annually over the past 25 years. Despite more intense precipitation in summer and autumn, the number of rainy days has decreased across all seasons. This concentration of rainfall over shorter periods likely prolongs the dry season and shortens the period of fungal sporulation. Future climate changes, including atmospheric dryness, drought, and desertification could further decrease allergenic fungal sporulation. It remains unclear whether the inverse relationship between pollen and fungal concentrations and distributions directly results from climate change. It is crucial to evaluate the patterns of aeroallergens and their associated health risks.

Identifying the critical windows of temperature extremes exposure and congenital heart diseases

The associations between atmospheric temperature and congenital heart disease (CHD) and its subtypes are still inconclusive. In this population-based retrospective case-control study, 643 CHD cases and 3,215 non-CHD controls were analyzed through distributed lag nonlinear model to estimate the effect of weekly temperature exposure on CHD risk and to identify potentially vulnerable windows. Through the binary logistic regression model, we found that elevated temperature in the first trimester was associated with an increased risk of overall CHD and ventricular septal defect (VSD) (OR: 1.059, 95% CI: 1.002-1.119; OR: 1.094, 95% CI: 1.005-1.190, respectively), while increased temperature in the second trimester was significantly positively correlated with atrial septal defect (ASD) risk. However, the results of the DLNM showed a nonlinear relationship between the weekly average temperature and the risk of total CHDs and the subtypes. Exposure to extremely, moderately, and mildly high temperatures significantly increased the risk of overall CHD, ASD and VSD, and the critical windows were mainly concentrated at the 5th-11th and 23rd-27th weeks of gestation. Low-temperature extreme exposure resulted in vulnerable windows for ASD only: 13th-14th gestational weeks. No significant positive associations were found between extreme temperature and patent ductus arteriosus or tetralogy of Fallot. In the current context of climate change, our results add new evidence to the present understanding of the effects of high- and low-temperature extreme exposure on CHD and its main subtypes.

Environmental impact of intravenous versus oral administration materials for acetaminophen and ketoprofen in a French university hospital: an eco-audit study using a life cycle analysis

PURPOSE

The combination of acetaminophen with a nonsteroidal anti-inflammatory drug is the cornerstone of perioperative multimodal analgesia. These drugs can be administered intravenously or orally as premedication, consistent with the concept of pre-emptive and preventive analgesia. We aimed to assess the environmental impact of their intravenous and oral administration in a French university hospital.

METHODS

We carried out a life cycle assessment to determine the amount of greenhouse gas emissions and depletion of water resources resulting from the oral vs intravenous administration of 1 g acetaminophen and 50 mg ketoprofen. We assessed two schemes of intravenous administration, depending on the use of the same or a different infusion set for each drug.

RESULTS

At our centre, the intravenous administration of both drugs was associated with the emission of 444-556 g CO2 equivalent (CO2e), and with 9.8-12.2 L of water waste. The oral administration of both drugs generated 8.36 g of CO2e emissions and consumed 1.16 L of water. At a national level, the switch from intravenous to oral premedication of the drugs could avoid the emission of 2,900-3,700 tons of CO2e and the waste of 58,000-74,000 m3 of water each year.

CONCLUSION

This eco-audit indicates that oral administration of acetaminophen and ketoprofen results in significantly lower carbon emissions and water consumption than intravenous administration. These findings highlight the importance of using the oral route for most patients, limiting intravenous administration for those with specific needs because of higher environmental impact and cost.

A scoping review of the impact of extreme weather events on health outcomes and healthcare utilization in rural and remote areas

BACKGROUND

Extreme weather events affect health by directly and indirectly increasing illness burdens and changing healthcare usage patterns. These effects can be especially severe in rural and remote areas, exacerbating existing health disparities, and necessitating urgent mitigation or adaptation strategies. Despite increased research on health and climate change, studies focusing on rural and remote populations remain limited. This study aimed to review the relationships among extreme weather events, healthcare utilization, and health outcomes in rural and remote populations, identify research gaps, and inform policy development for adaptation and disaster management in these settings.

METHODS

A systematic scoping review was registered and conducted following the PRISMA-ScR guidelines. The search databases included PubMed, Web of Science, Scopus, the Cochrane Library, ProQuest, and the WHO IRIS. The included studies were primary research, focused on rural or remote areas, and investigated the effects of extreme weather events on either health outcomes or healthcare utilization. There were no methodological, date or language restrictions. We excluded protocols, reviews, letters, editorials, and commentaries. Two reviewers screened and extracted all data, other reviewers were invited to resolve conflicts. Findings are presented numerically or narratively as appropriate.

RESULTS

The review included 135 studies from 31 countries, with most from high-income countries. Extreme weather events exacerbate communicable and noncommunicable diseases, including cardiorespiratory, mental health, and malnutrition, and lead to secondary impacts such as mass migration and increased poverty. Healthcare utilization patterns changed during these events, with increased demand for emergency services but reduced access to routine care due to disrupted services and financial constraints.

CONCLUSIONS

The results highlighted the essential role of community and social support in rural and remote areas during extreme weather events and the importance of primary healthcare services in disaster management. Future research should focus on developing and implementing effective mitigation and adaptation programs tailored to the unique challenges faced by these populations.

Exploring the Association Between Floods and Diarrhea among Under-five Children in Rural India

OBJECTIVE

Flood is one of the major public health concerns increasing the risk of childhood diarrhea. This study aims to explore the association of floods with diarrhea among under-five children in rural India.

METHODS

A cross-sectional study was carried out using large-scale nationally representative data from the National Family Health Survey-5. The Central Water Commission reports between the years 2018 and 2020 were used to group all the districts as non-flood-affected districts or flood-affected districts. Bivariate and multivariate logistic regression models were employed to assess the association of floods with childhood diarrhea.

RESULTS

The prevalence of diarrhea was higher among children exposed to three consecutive floods during the year 2019-21 than those children not exposed to flood. Children exposed to flood three times between the year 2018-19 to 2020-21 were associated with a 34% higher likelihood of developing diarrhea than those children exposed to flood one or two times.

CONCLUSIONS

Our study suggests that community health workers should target mothers belonging to the poor wealth quintile, young mothers, and mothers with young infants and more children to receive child health related counseling in flood-prone areas.

Drawing from the insights of biology, sustainable healthcare systems should prioritise robustness over optimisation

The concept of performance has gradually become established in health policies. Presented as necessary and positive, it is often reduced to efficiency, which results in policies and management styles aimed at optimisation. While they are supposed to guarantee the sustainability of our healthcare systems, these practices have made them fragile. Insights from the life sciences help us understand why. Indeed, biologists observe that living beings do not prioritise optimisation but robustness. To cope with fluctuations, a robust organisation operates with redundancies, apparent waste, heterogeneity, organised fluctuations, slowness, and hesitation. It functions sub-optimally. This article offers a theoretical reflection and management directions for more robust healthcare systems.

Assessment of the carbon footprint of total hip arthroplasty and opportunities for emission reduction in a UK hospital setting

Aims

This study aimed to assess the carbon footprint associated with total hip arthroplasty (THA) in a UK hospital setting, considering various components within the operating theatre. The primary objective was to identify actionable areas for reducing carbon emissions and promoting sustainable orthopaedic practices.

Methods

Using a life-cycle assessment approach, we conducted a prospective study on ten cemented and ten hybrid THA cases, evaluating carbon emissions from anaesthetic room to recovery. Scope 1 and scope 2 emissions were considered, focusing on direct emissions and energy consumption. Data included detailed assessments of consumables, waste generation, and energy use during surgeries.

Results

The carbon footprint of an uncemented THA was estimated at 100.02 kg CO2e, with a marginal increase to 104.89 kg CO2e for hybrid THA. Key contributors were consumables in the operating theatre (21%), waste generation (22%), and scope 2 emissions (38%). The study identified opportunities for reducing emissions, including instrument rationalization, transitioning to LED lighting, and improving waste-recycling practices.

Conclusion

This study sheds light on the substantial carbon footprint associated with THA. Actionable strategies for reducing emissions were identified, emphasizing the need for sustainable practices in orthopaedic surgery. The findings prompt a critical discussion on the environmental impact of single-use versus reusable items in the operating theatre, challenging traditional norms to make more environmentally responsible choices.

Is heat wave a predictor of diarrhoea in Dhaka, Bangladesh? A time-series analysis in a South Asian tropical monsoon climate

While numerous studies have assessed the association between temperature and diarrhoea in various locations, evidence of relationship between heat wave and diarrhoea is scarce. We defined elevated daily mean and maximum temperature over the 95th and 99th percentiles lasting for at least one day between March to October 1981-2010 as TAV95 and TAV99 and D95 and D99 heat wave, respectively. We investigated the association between heat wave and daily counts of hospitalisations for all-cause diarrhoea in Dhaka, Bangladesh using time series regression analysis employing constrained distributed lag-linear models. Effects were assessed for all ages and children aged under 5 years of age. Diarrhoea hospitalisation increased by 6.7% (95% CI: 4.6%- 8.9%), 8.3% (3.7-13.1), 7.0 (4.8-9.3) and 7.4 (3.1-11.9) in all ages on a TAV95, TAV99, D95 and D99 heat wave day, respectively. These effects were more pronounced for under-5 children with an increase of 13.9% (95% CI: 8.3-19.9), 24.2% (11.3-38.7), 17.0 (11.0-23.5) and 19.5 (7.7-32.6) in diarrhoea hospitalisations on a TAV95, TAV99, D95 and D99 heat wave day, respectively. At lags of 3 days, we noticed a negative association indicating a 'harvesting' effect. Our findings suggest that heat wave was a significant risk factor for diarrhoea hospitalisation in Dhaka. Further research is needed to elucidate the causal pathways and identify the preventive measures necessary to mitigate the impacts of heat waves on diarrhoea. Given that no heat wave definitions exist for Dhaka, these results may help to define heat waves for Dhaka and trigger public health interventions including heat alerts to prevent heat-related morbidity in Dhaka, Bangladesh.

Impacts of climate change on diarrhoeal disease hospitalisations: How does the global warming targets of 1.5-2°C affect Dhaka, Bangladesh?

Dhaka is one of the world's densely populated cities and faces significant public health challenges including high burden of diarrhoeal diseases. Climate change is intensifying existing environmental problems including urban heat island effect and poor water quality. While numerous epidemiological studies have linked meteorological factors to diarrhoeal diseases in Bangladesh, assessment of the impacts of future climate change on diarrhoeal diseases is scarce. We provide the assessment of climate change impacts on diarrhoeal disease in Dhaka and project future health risks under climate change scenarios. About 3 million acute diarrhoea cases presenting to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b) during 1981-2010 were linked to daily temperature, rainfall and humidity and association investigated using time series adapted negative binomial regression models employing constrained distributed lag linear models. The findings were applied to climate projections to estimate future risks of diarrhoea under various global warming scenarios. There was a significantly raised risk of diarrhoea hospitalisation in all ages with daily mean temperature (RR: 3.4, 95% CI: 3.0-3.7) after controlling for the confounding effects of heavy rainfall, humidity, autocorrelations, day of the week effect, long-term time, and seasonal trends. Using the incidence rate ratio (IRR) of 1.034, temperature increases based on the global warming targets of 1.5-2°C could result in an increase of diarrhoea hospitalisations by 4.5-7.4% in all age groups by the 2100s. These effects were more pronounced among <5 children where the predicted temperature increases could raise diarrhoea hospitalisation by 5.7% - 9.4%. Diarrhoea hospitalisation will increase significantly in Dhaka even if the global warming targets adopted by the Paris Agreement is reached. This underscores the importance of preparing the city for management and prevention of diarrhoeal diseases.

Mental health, subjective experiences and environmental change

This article responds to Coope's call for the medical humanities to address the climate crisis as a health issue. Coope proposes three areas for progress towards ecological thinking in healthcare, with a focus on ecological mental health. The article emphasises the need to understand the cultural dimensions of mental health and proposes an interdisciplinary approach that integrates insights from the arts and humanities. It examines the impact of climate change on mental health, drawing on The Rockefeller Foundation - Lancet Commission on Planetary Health and recent studies. The discussion focuses on the intersection of mental health, subjective experience and environmental change. Focusing on emotional experiences as constructed from biological and cultural elements, the article proposes a holistic approach to mental health. It proposes two converging lines of research, in constant interaction: first, a historical and cultural research of those concepts, practices and symbols related to the environment, emphasising a cultural history of nature; and second, a synchronous research, drawing on anthropology, sociology and participatory art-based research, to understand how these aforementioned elements influence our current relations with nature. The article concludes by emphasising the urgency of developing narratives and histories that redirect temporal trajectories towards a better future, while respecting and acknowledging diverse narratives of individual experience. It calls for collaborative efforts from the medical humanities to contribute to a more comprehensive understanding of the complex relationship between mental health, nature and ecological crisis.

Sustainable orthopaedic surgery: Initiatives to improve our environmental, social and economic impact

In response to appeals from the WHO and The Lancet, a collaborative statement from over 200 medical journals was published in September 2021, advising international governments to combat the "catastrophic harm to health" from climate change. Healthcare, specifically surgery, constitutes a major contributor to environmental harm that remains unaddressed. This article provides practical guidance that can be instituted at a departmental, hospital and national level to institute transformative, sustainable efforts into practice. We also aim to provoke healthcare leaders to discuss policy-making with respect to this issue and highlight the necessity for sustainability to become a core domain of quality improvement. The average orthopaedic service produces 60% more waste than any other surgical specialty. Fortunately, simple measures such as a comprehensive education programme can decrease waste disposal costs by 20-fold. Other simple and effective "green" measures include integrating carbon literacy into surgical training, prioritising regional anaesthesia and conducting recycling audits. Furthermore, industry must take accountability and be incentivised to limit the use of single-item packaging and single-use items. National policymakers should consider the benefits of reusable implants, reusable surgical drapes and refurbishing crutches as these are proven cost and climate-effective interventions. It is crucial to establish a local sustainability committee to maintain these interventions and to bridge the gap between clinicians, industry and policymakers.

Environmental impact of anesthetic drugs

PURPOSE OF REVIEW

The environmental impact of anesthesia far exceeds that of other medical specialties due to our use of inhaled anesthetic agents (which are potent greenhouse gases) and many intravenous medications.

RECENT FINDINGS

Calls for reducing the carbon footprint of anesthesia are ubiquitous in the anesthesia societies of developed nations and are appearing in proposed changes for hospital accreditation and funding in the United States. The body of research on atmospheric, land and water impacts of anesthetic pharmaceuticals is growing and generally reinforces existing recommendations to reduce the greenhouse gas emissions of anesthesia care.

SUMMARY

The environmental impact of anesthesia care should factor into our clinical decisions. The onus is on clinicians to safely care for our patients in ways that contribute the least harm to the environment. Intravenous anesthesia and regional techniques have less environmental impact than the use of inhaled agents; efforts to reduce and properly dispose of pharmaceutical waste are central to reducing environmental burden; desflurane should not be used; nitrous oxide should be avoided except where clinically necessary; central nitrous pipelines should be abandoned; low fresh gas flows should be utilized whenever inhaled agents are used.

Health system adaptations for extreme heat: Protocol for an international scoping review of reviews

OBJECTIVE

The objective of this study is to map the international evidence for extreme heat related adaptation strategies by health systems, with a particular focus on how heat-vulnerable populations and local situational awareness are considered in these strategies.

INTRODUCTION

Since the Paris Climate Accords in 2015, awareness has increased of the health risks posed by extreme heat along with interest in adaptations which aim to reduce heat-health-risks for vulnerable populations. However, the extant literature on these adaptations suggest they are insufficient, and call for research to examine whether, how, and what adaptations for extreme heat are effective as public health interventions.

INCLUSION CRITERIA

We will include English-language review articles describing and/or evaluating health system adaptations for extreme heat. Health systems will be defined broadly using the WHO Building Blocks model [1] and adaptations will range from the individual level to institutional, regional and national levels, with particular attention to localisation and the protection of vulnerable individuals.

METHODS

A comprehensive literature search of the published literature will be conducted using MEDLINE, Embase, CINAHL, the Cochrane Library and Web of Science. Searches will be limited to reviews published since 2015 in the English language. Results will be exported to EndNote for screening (with a sample checked by two reviewers to ensure consistency). A complementary search for related reports by major international agencies (e.g. WHO; International Association of Emergency Managers), as well as local searches for current guidance and case studies, will be conducted in parallel. Data from included papers will be presented in tables with a narrative commentary.

Plastic waste in major orthopaedic surgical procedures: descriptive and sources of improvement

PURPOSE

The healthcare industry is a significant contributor to single-use plastic waste, particularly in the operating room (OR). This study aims to assess the volume of plastic waste generated during total hip, knee, and shoulder arthroplasty in the OR and identify areas for improvement.

METHOD

A prospective transversal study at a tertiary hospital was conducted. All total knee arthroplasty (TKA), total hip arthroplasty (THA), and reverse shoulder arthroplasty (RSA) from April to July 2021 were included. The weight of plastic used during patient preparation, anaesthesia, and the surgical procedure was recorded. To calculate the environmental impact, a calculator generated by the United States Environmental Protection Agency (U.S. EPA) was used.

RESULTS

A total of 68 surgeries were included. The mean weight of plastic used in total was 7.3 kg (SD 0.48), with the highest yielding procedure being TKA. It generated a mean of 7.63 kg (SD 0.28), followed by THA at 7.28 kg (SD 0.43), and RSA at 6.87 kg (SD 0.47). Various scenarios were simulated to evaluate the potential impact of reducing plastic waste. Substituting plastic wrapping with recyclable materials could save 159.6 kg of CO2 emissions per 100 prostheses. Eliminating non-essential equipment and adopting reusable fabric drapes also showed a significant potential.

CONCLUSION

The findings highlight the need for environmentally sustainable practices in the OR. In this way, the healthcare sector can contribute to a cleaner and greener world without compromising patient safety.

Teaching global interdependence to health professions students during the Anthropocene epoch: Findings from documentary analysis of an interprofessional education course

AIM(S)

To examine the effects of new course material that incorporated the Anthropocene and The Centers for Disease Control's (CDC) 'Climate Effects on Health' framework into an IPE course to enhance students' understanding global interdependence.

BACKGROUND

Teaching global interdependence with a suitable framework and relevant content in an introductory Interprofessional Education course in undergraduate programs is challenging when these early learners who do not have significant clinical experience. Therefore, it is necessary to adapt these courses to provide a framework that all students can relate to regardless of previous experience.

DESIGN

The design for this study was qualitative document analysis.

METHOD

The required introductory IPE course was for students on the programs offered by the College of Health Sciences and the School of Nursing. Students (n = 142) from seven health professions programs, including athletic training (n=9), nursing (n=70), nutrition and dietetics (n=8), occupational therapy (n=15), physical therapy (n=31), radiation therapy (n=2) and magnetic resonance imaging and pre-professional students from other majors (n=5) were enrolled in this IPE course. The study used data derived from the final reflections submitted by the students. The CQI analysis focused on students enrolled in a dedicated interprofessional course related to health professions.

RESULTS

Ways interprofessional teams can address global challenges like the Anthropocene, climate-related illnesses and severe weather events were revealed in student responses. Three themes that emerged from the student responses included: public health collaborations, holistic health promotion and policy advocacy.

CONCLUSION

Incorporating the concept of Anthropocene and the 'Climate Effects on Health' framework into an IPE course can be a promising approach to shaping students' perception and enhancing their knowledge about global interdependence. By doing so, students can gain a deeper understanding of how human activities have an impact on the climate and ecology of the planet and how severe weather can lead to various health problems.

Defending and Defining Environmental Responsibilities for the Health Research Sector

Six planetary boundaries have already been exceeded, including climate change, loss of biodiversity, chemical pollution, and land-system change. The health research sector contributes to the environmental crisis we are facing, though to a lesser extent than healthcare or agriculture sectors. It could take steps to reduce its environmental impact but generally has not done so, even as the planetary emergency worsens. So far, the normative case for why the health research sector should rectify that failure has not been made. This paper argues strong philosophical grounds, derived from theories of health and social justice, exist to support the claim that the sector has a duty to avoid or minimise causing or contributing to ecological harms that threaten human health or worsen health inequity. The paper next develops ideas about the duty's content, explaining why it should entail more than reducing carbon emissions, and considers what limits might be placed on the duty.

Adherence with statins and all-cause mortality in days with high temperature

PURPOSE

It has been suggested that statins may exert thermo-protective effects that can reduce mortality on hot days. We aimed to examine the relationship between statin adherence and mortality in days with high temperature.

METHODS

Utilizing data from a prior historical new-user cohort study, we analyzed a cohort of 229 918 individuals within a state-mandated health provider in Israel who initiated statin therapy between 1998 and 2006. Adherence to statins was assessed through the mean proportion of days covered (PDC) with statins during the follow-up period. The study's primary outcome was all-cause mortality during hot days.

RESULTS

During the study follow-up period, a total of 13 165 individuals (5.7%) died. In a multivariable model, a 10% increase in PDC with statins was associated with an HR of (0.85; 95% CI: 0.72-1.00) for deaths (n = 16) in extremely hot days (≥39°C). This association was numerically stronger compared to HR = 0.94 (0.93-0.94) in cooler days and displayed a significant difference between sexes. In males, the fully-adjusted HR for a 10% increase in PDC with statins was 0.66 (0.45-0.95), while in women, it was 0.98 (0.78-1.23). In contrast, no such effect modification was observed for death in cooler days.

CONCLUSIONS

These findings align with earlier research, supporting the notion that adherence with statin treatment may be associated with a reduced risk of death during extremely hot days, particularly among men.

Promoting transdisciplinary collaboration in academia: uniting for climate-resilient health

In a world where some regions are directly experiencing the effects of the climate change, while others are more vulnerable; this article dives into the deep and frequently catastrophic impact of the climate change on vulnerable countries. This review emphasizes the need for transdisciplinary academic collaboration, including social scientists, healthcare professionals, engineers, policy experts, and climate scientists, and underscores academia’s potential role in advancing climate-resilient health systems in these areas. The study promotes inclusive research that prioritizes at-risk groups, involves communities, and supports culturally sensible methodologies. Beyond their traditional tasks, academia has an obligation for action, learning, innovation, and change. To address the complex health concerns brought on by the planetary crisis, collaboration across academic fields and in tandem with communities, governments, and international organizations is crucial. Ongoing collaboration between academia, governments, and stakeholders is crucial to developing healthcare systems and technologies that are climate resilient. The complex role of academia involves developing pioneering solutions in healthcare for a sustainable future, advocating for policies based on evidence, and educating the next generation of professionals.

How climate change degrades child health: A systematic review and meta-analysis

BACKGROUND

Children are more vulnerable than adults to climate-related health threats, but reviews examining how climate change affects human health have been mainly descriptive and lack an assessment of the magnitude of health effects children face. This is the first systematic review and meta-analysis that identifies which climate-health relationships pose the greatest threats to children.

OBJECTIVES

We reviewed epidemiologic studies to analyse various child health outcomes due to climate change and identify the relationships with the largest effect size. We identify population-specific risks and provide recommendations for future research.

METHODS

We searched four large online databases for observational studies published up to 5 January 2023 following PRISMA (systematic review) guidelines. We evaluated each included study individually and aggregated relevant quantitative data. We used quantitative data in our meta-analysis, where we standardised effect sizes and compared them among different groupings of climate variables and health outcomes.

RESULTS

Of 1301 articles we identified, 163 studies were eligible for analysis. We identified many relationships between climate change and child health, the strongest of which was increasing risk (60 % on average) of preterm birth from exposure to temperature extremes. Respiratory disease, mortality, and morbidity, among others, were also influenced by climate changes. The effects of different air pollutants on health outcomes were considerably smaller compared to temperature effects, but with most (16/20 = 80 %) pollutant studies indicating at least a weak effect. Most studies occurred in high-income regions, but we found no geographical clustering according to health outcome, climate variable, or magnitude of risk. The following factors were protective of climate-related child-health threats: (i) economic stability and strength, (ii) access to quality healthcare, (iii) adequate infrastructure, and (iv) food security. Threats to these services vary by local geographical, climate, and socio-economic conditions. Children will have increased prevalence of disease due to anthropogenic climate change, and our quantification of the impact of various aspects of climate change on child health can contribute to the planning of mitigation that will improve the health of current and future generations.

Environmental Sustainability and MRI: Challenges, Opportunities, and a Call for Action

The environmental impact of magnetic resonance imaging (MRI) has recently come into focus. This includes its enormous demand for electricity compared to other imaging modalities and contamination of water bodies with anthropogenic gadolinium related to contrast administration. Given the pressing threat of climate change, addressing these challenges to improve the environmental sustainability of MRI is imperative. The purpose of this review is to discuss the challenges, opportunities, and the need for action to reduce the environmental impact of MRI and prepare for the effects of climate change. The approaches outlined are categorized as strategies to reduce greenhouse gas (GHG) emissions from MRI during production and use phases, approaches to reduce the environmental impact of MRI including the preservation of finite resources, and development of adaption plans to prepare for the impact of climate change. Co-benefits of these strategies are emphasized including lower GHG emission and reduced cost along with improved heath and patient satisfaction. Although MRI is energy-intensive, there are many steps that can be taken now to improve the environmental sustainability of MRI and prepare for the effects of climate change. On-going research, technical development, and collaboration with industry partners are needed to achieve further reductions in MRI-related GHG emissions and to decrease the reliance on finite resources. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 6.

Climate change: why oncologists need to get involved

A warming planet will have devasting effects on human health - including the care, diagnosis, prevention, and treatment of cancer patients. As oncology health care professionals, we have a moral and professional obligation to educate our peers, health systems, the public, and other stakeholders as to the dangers they can expect, and how they can be prevented or mitigated. There are numerous ways that we, as trusted messengers, can take action, either personally, locally, nationally, or by supporting non-profit organizations advocating for climate change and cancer. Impact of climate change on human health. Source: National Center for Environmental Health, Centers for Disease Control and Prevention, https://www.cdc.gov/climateandhealth/effects/default.htm .

The importance of teaching climate-health literacy in psychotherapeutic training and continuing education

Climate-health literacy is the ability to find, access, understand, interpret, evaluate, and communicate information about the impact of climate change on human health and to make decisions and act accordingly to that information. Climate change affects people's health in numerous ways, both directly and indirectly, e.g., by increasing the risks of cardiovascular disease, infections, depression, anxiety disorders, and trauma. It is important for health professionals to understand the complex interaction between climate change and health. A teaching concept is presented that incorporates the core elements of climate-health literacy. On a first level, physical and climatological basics are taught, direct and indirect impacts of climate change on human health, climate protective measures, the psychological background of climate-protective behavior, and professional ethics. Furthermore, via self-awareness and self-reflection, the impact of climate change on the student's mental health should be evaluated. In an advanced level, the direct and indirect impacts of climate change on mental health are taught, coping strategies, resilience, and vulnerability, as well as the role of health-care professionals in the climate crisis. In expert-level lectures, the knowledge can be deepened, and special content like activist burnout can be addressed.

[Sustainability in intensive and emergency care : A nationwide survey by the German Society of Medical Intensive Care and Emergency Medicine]

BACKGROUND

The impact of climate change on humans is well known. However, the health care system is also a relevant contributor, accounting for up to 5-7% of global greenhouse gas emissions, and work should be adapted to be more sustainable.

AIM

The survey investigated whether sustainability plays a role in hospitals and specifically in the field of emergency and intensive care. Concrete measures and which hurdles are already recognized were also inquired.

MATERIALS AND METHODS

The "AG Nachhaltigkeit" (working group on sustainability) of the "Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin" (DGIIN) conducted an electronic survey among the staff of intensive care units, emergency rooms, and ambulance services in Germany.

RESULTS

In all, 218 survey results were included in the analysis: 108 (50%) participants were from the nursing sector and 98 (45%) belonged to the medical staff. The majority of participants work in an intensive care unit (181 [83%]) followed by intermediate care unit (52 [24%]). A total of 104 (47%) participants indicated that their workplace had already implemented sustainability measures. However, when asked whether decision-makers in the workplaces incorporate sustainability into their decisions, management scored highest with only 20%. Potential for improvement is seen in energy and waste management, among others.

CONCLUSION

The survey results show that (1) employees are highly motivated to address the issue of sustainability and to implement measures, (2) the potential to establish a resource-saving and environmentally friendly hospital is far from being exhausted, and (3) it must become a priority that decision-makers in the hospital propagate sustainability, make processes transparent, and support the motivation of employees on the subject of sustainability. In addition, this process must be supported by politicians and health insurance companies.

Environmental sustainability in healthcare: A qualitative study of the perspectives of nursing, medical and public health students in Kazakhstan

THE AIM WAS

This study explored the perspectives of nursing, medical and public health students on environmental sustainability in healthcare.

BACKGROUND

The healthcare sector has increasingly recognized the importance of adopting environmental sustainability over the past few years. This growing awareness emphasizes the need to thoroughly assess the connection between health care and environmental responsibility.

DESIGN

Qualitative descriptive-exploratory design.

METHODS

This study explored the views on environmental sustainability in health care of 29 nursing, medical and public health students at three universities in Kazakhstan through focus group discussions. Thematic analysis was used in the data analysis. Data collection was carried out from June to August 2023.

RESULTS

Using semantic thematic analysis, 209 initial codes were extracted, and then similar codes and meanings were grouped, leading to 21 categories until the development of the five significant themes. The five main themes are 'the impact of the environment on health', 'environmental sustainability practices in healthcare care', 'the importance of interdisciplinary collaboration in environmental sustainability in healthcare', 'intrinsic motivation to engage in environmental sustainability practices in healthcare' and 'challenges and barriers to practicing environmental sustainability in healthcare'.

CONCLUSIONS

The study findings suggest the critical aspect of addressing environmental sustainability through interprofessional collaboration and working on intrinsic motivation among health professionals. Furthermore, our study contributes in several ways to our understanding of environmental sustainability in healthcare. Provides a basis for clinicians, educators and policy makers to consider adding sustainability to their agenda to prepare future health professionals.

The nexus among CO2 emission, health expenditure and economic development in the OECD countries: New insights from a cross-sectional ARDL model

To find a way to realize sustainable development, this paper applied a cross-sectional ARDL (CS-ARDL) method to explore the interaction between carbon emissions, economic development, and health care expenditure for OECD countries. Firstly, we conduct a cross-sectional test to check whether the data is confronted with this issue. Secondly, we conduct a panel unit root test and cointegration test to confirm whether the ARDL-based method is suitable for our data. Thirdly, we analyze the results and provide possible explanations. Lastly, we conduct a short-term causality test to detect the connection between different variables. The main conclusion of our study includes: 1) Health care is a necessity in OECD countries. 2) Environmental deterioration places a heavy burden on health care expenditure in OECD countries. 3) Health care expenditure of last year negatively affects health care expenditure. 4) There is a short-run causality relationship from CO2, economic development, and dependency rate of youth to health care expenditure in OECD countries. Related policy proposals are provided according to our analysis of the results.

Disparities in the association between ambient temperature and preterm birth according to individual and regional characteristics: a nationwide time-stratified case-crossover study

BACKGROUND

Several studies have reported that climate change elevates heat exposure in pregnant women and high temperatures during pregnancy are associated with preterm births (PTBs). Although the association might be disproportionate, related evidence remains sparse. We evaluated the disproportionate risk of PTB associated with ambient temperature during pregnancy by individual and regional characteristics in South Korea.

METHODS

We collected data on birth certificates and daily mean temperatures during the period from 2011 to 2019. A time-stratified case-crossover design was used to investigate the association between temperature and PTB and stratified analyses were conducted to examine the effect modification of individual and regional characteristics.

RESULTS

A total of 160,067 singleton PTBs were recorded in Korea from 2011 to 2019. A 5℃ increase in the mean temperature during the last four weeks before delivery was associated with an increased risk of PTB with an odds ratio (OR) of 1.03 (95% confidence interval [CI]: 1.02, 1.05), and the association was more evident in mothers aged ≥35 years (OR: 1.06 [95% CI: 1.03, 1.10]) and with low education levels (OR: 1.04 [95% CI: 1.02, 1.05]). Additionally, the estimated risk was evident in districts with lower medical resources and more prominent disparities were shown by individual and regional characteristics in rural areas than in urban areas.

CONCLUSIONS

This study provides evidence that the risk of PTB related to ambient temperature is disproportionate by individual and regional characteristics and suggests the need for public health policies to alleviate the disparities, especially in rural areas.

The Climate Crisis and Breastfeeding: Opportunities for Resilience

The climate crisis is an emerging global challenge that poses potential risks to breastfeeding practices and outcomes. There are multifaceted effects of climate change affecting the breastfeeding dyad across environmental, societal, and human health dimensions. Breastfeeding support in the face of climate change will require solutions at the structural level-healthcare, community, and workplace settings-and at the mother-infant dyad level. Breastfeeding can additionally be an adaptive response to crisis situations and can mitigate some of the environmental challenges associated with climate change. Despite the undeniable significance of climate change on breastfeeding (and vice versa), our perspective as experts in the field is that this topic has not been systematically addressed. Although we highlight some of the challenges, potential solutions, and co-benefits of breastfeeding in the context of climate change, there are numerous issues that could be further explored and necessitate additional preparedness planning.

Estimating the environmental impact of endoscopic activity at a tertiary center: a pilot study

INTRODUCTION

The growing number of endoscopic procedures, frequently requiring single-use disposable instruments, is responsible for the production of a large amount of waste. To this date, the reality of waste production at large European Gastroenterology centers is unknown. This study aimed to estimate the amount of waste due to endoscopic practice at a tertiary center in Portugal.

METHODS

We performed a prospective study to calculate the mass (in kg) of residues generated during a period of 5 working days of endoscopic practice. We included residues produced at endoscopy suites, pre and postprocedure areas and during endoscope reprocessing. Residues were categorized as non-dangerous (groups I/II), of biologic risk (group III) and specific hazardous hospital residues (group IV). The production of residues separated for recycling/valorization (paper/card and plastic) was also quantified. The volume of water used for reprocessing an endoscope was also assessed.

RESULTS

During the analyzed period, 241 endoscopic procedures were performed. A total of 443.2 kg of waste (22.6 kg from groups I/II, 266.9 kg from group III and 3.9 kg from group IV) were produced, most from group III (75%). For each endoscopic procedure, 1.8 kg of waste was generated. Of the total waste mass, 17.8% was separated for recycling/valorization. A volume of 55L of water was required for reprocessing one endoscope.

CONCLUSION

Each endoscopic procedure generated a significant amount of waste and water consumption during reprocessing. These real-life analyses are a pivotal step before implementing effective measures to improve resource utilization and more sustainable practices.

Hearing Loss and Disorders: The Repercussions of Climate Change

PURPOSE

Climate change is considered to be the greatest threat to human health in the 21st century, and its effects are accelerating. Extensive research has clearly demonstrated its increasing impact across the continuum of health conditions. Despite this, there has been limited attention to the ramifications of climate change on hearing loss and hearing disorders. This lack of consideration is somewhat surprising as the environment itself and its changing nature have a substantial effect on hearing.

METHOD

Tackling climate change could be the greatest global health opportunity of the 21st century. To address this issue, this tutorial provides a general introduction to climate change and its three major elements (pollution, infectious diseases, and extreme weather events) and their effects on health. The substantial consequences of climate change for the incidence, development, and exacerbation of hearing loss and disorders are clearly described and detailed.

CONCLUSIONS

The challenge of responding to this very real and escalating threat to hearing requires a combination of prevention, advocacy, and education. These three roles place audiologists in the perfect position to take action on the far-reaching effects of climate change on hearing loss and disorders. To respond to this challenge and to fulfill these roles, several strategies, ranging from the individual level to the global level, are delineated for audiologists to incorporate into their practice.

Barker's Hypothesis Among the Global Poor: Positive Long-Term Cardiovascular Effects of in Utero Famine Exposure

An influential literature on the Developmental Origins of Health and Disease (DOHaD) has documented that poor conditions in utero lead to higher risk of cardiovascular disease at older ages. Evidence from low-income countries (LICs) has hitherto been missing, despite the fact that adverse in utero conditions are far more common in LICs. We find that Malawians exposed in utero to the 1949 Nyasaland famine have better cardiovascular health 70 years later. These findings highlight the potential context specificity of the DOHaD hypothesis, with in utero adversity having different health implications among aging LIC individuals who were exposed to persistent poverty.

The impact of climate change on cancer nursing in Palestine

Cancer is the third leading cause of death in Palestine, with many cancers diagnosed at a late stage. In contrast to the developed world, two thirds of cancer diagnoses occur between the ages of 15 and 64, moreover, 10% of all cancer diagnoses occur in children under the age of 10 (compared to 0.05% of all new cancer diagnoses in the UK). Cancer nursing as a speciality in Palestine is newly established in the last 5 years; partly helped by the introduction of the Higher Diploma in Cancer and Palliative Care Nursing, and more recently the delivery of the first intake of the Master of Science in Cancer and Palliative Care Nursing at Bethlehem University. There are many challenges faced by cancer patients and nurses in Palestine; there is only one facility in the West Bank that delivers radiotherapy, 2 PET-CT scanners for the whole of the West Bank, with no PET-CT or radiotherapy facilities in Gaza. There are 2 haematology units in the West Bank that perform autologous stem cell transplants for adults and any haematology patient (adult or child) requiring an allogeneic stem cell/bone marrow transplant has to be referred to neighbouring Israel or Jordan. Climate change might have both a direct and indirect impact on the growth of cancers and on cancer treatment and oncology nurses. Over the last 150 years the planet has warmed by over one degree Celsius resulting in disastrous consequences for the environment. Nurses make up the largest number of the healthcare workforce and are ideally placed to have a positive impact on the global warming crisis due to their leadership roles as well as their work in health promotion. They equally do a lot to help cancer patients to deal with its effects and often care for patients from marginalised groups. It is important for nurses to take the lead and move immediately to make health systems more resistant to climate change.

Climate attribution of interpersonal violence: International evidence

Anthropogenic climate change is increasingly threatening interpersonal violence, yet global evidence for related impacts and potential transmission mechanisms remains limited. We examine whether and how climate change, particularly climate extremes, affects interpersonal violence. Using the panel data of 140 countries and regions from 2000 to 2019, we find that hot and wet extremes precipitated increase in homicide rates globally. Economic level, inequality, and resources scarcity were important intermediaries through which climate extremes affected homicide, while the direct effects still dominated the total effects. We then reveal the heterogeneous effects of climate extremes, further suggesting that poor countries and regions with relatively small contributions to climate change were particularly sensitive to climate extremes. These findings elucidate a strong climate-violence link, helping explain implications of facilitating violence prevention and mitigating climate change.

Work as a social determinant of health in high-income countries: past, present, and future

This paper, the first in a three-part Series on work and health, provides a narrative review of research into work as a social determinant of health over the past 25 years, the key emerging challenges in this field, and the implications of these challenges for future research. By use of a conceptual framework for work as a social determinant of health, we identified six emerging challenges: (1) the influence of technology on the nature of work in high-income countries, culminating in the sudden shift to telework during the COVID-19 pandemic; (2) the intersectionality of work with gender, sexual orientation, age, race, ethnicity, migrant status, and socioeconomic status as codeterminants of health disparities; (3) the arrival in many Organisation for Economic Co-operation and Development countries of large migrant labour workforces, who are often subject to adverse working conditions and social exclusion; (4) the development of precarious employment as a feature of many national labour markets; (5) the phenomenon of working long and irregular hours with potential health consequences; and (6) the looming threat of climate change's effects on work. We conclude that profound changes in the nature and availability of work over the past few decades have led to widespread new psychosocial and physical exposures that are associated with adverse health outcomes and contribute to increasing disparities in health. These new exposures at work will require novel and creative methods of data collection for monitoring of their potential health impacts to protect the workforce, and for new research into better means of occupational health promotion and protection. There is also an urgent need for a better integration of occupational health within public health, medicine, the life sciences, and the social sciences, with the work environment explicitly conceptualised as a major social determinant of health.

Development of a Self-Assessment Audit Instrument to Support Climate-Conscious Community Pharmacy Practice and Education

Climate breakdown continues to occur at an alarming pace, and the need for all citizens and professionals to respond has never been so urgent. Healthcare work contributes significantly to greenhouse gas (GHG) emissions, representing an opportunity and responsibility for pharmacists to engage in more climate-conscious practices. A key informant interview-based qualitative research method was undertaken to identify options and strategies for community pharmacists to contribute positively to achieving climate-related carbon footprint reduction goals. A total of 10 thought leaders in climate-conscious pharmacy practice were interviewed using a semi-structured protocol, and a constant comparative data analysis method was used to identify common themes and priorities. A self-assessment audit instrument (SAAI) was identified as a positive first step to build awareness, knowledge, skills, and confidence amongst community pharmacists regarding actionable climate-conscious community pharmacy practice. The SAAI supported both self-reflection and self-assessment, while signposting additional resources that could be accessed by pharmacists to continue their learning and professional development. Further work in this area is required if community pharmacy is to contribute positively to climate reduction targets locally and globally.

Strategies for public health adaptation to climate change in practice: social learning in the processionary Moth Knowledge Platform

Social learning theory can support understanding of how a group of diverse actors addresses complex challenges related to public health adaptation. This study focuses on one specific issue of public health adaptation: oak processionary moth (OPM) adaptation. With a social learning framework, we examined how public health adaption strategies gradually develop and are adjusted on the basis of new knowledge and experiences. For this qualitative case study, data were collected through 27 meetings of the Processionary Moth Knowledge Platform in the Netherlands and six additional interviews. Results indicate that relations between stakeholders, including experts played a major role in the learning process, facilitating the development and implementation of OPM adaptation and connecting local challenges to national adaptation strategies. Uncertainties regarding knowledge and organization were recurrent topics of discussion, highlighting the iterative and adaptive nature of public health adaptation. The study emphasizes the importance of building relationships among stakeholders and small steps in the learning process that can lead to the creation of new strategies and, if successful, the prevention of negative health impacts.

Predicting climate-change induced heat-related illness risk in Grand Canyon National Park visitors

BACKGROUND

The climate crisis is the greatest public health threat of the 21st century. Excessive heat is responsible for more deaths than any other extreme weather event, and the frequency, intensity, and duration of extreme heat events are increasing globally due to climate change. Exposure to excessive heat can result in heat related illnesses (HRIs) and long-term poor health outcomes. Physical exertion, sudden exposure to excessive heat, and the lack of physical or behavioral adaptation resources are all associated with greater HRI risk, which is expected to increase for visitors to Grand Canyon National Park (GCNP) and other public lands as climate change worsens.

OBJECTIVES

Our objectives were to understand 1) the relationship between weather and HRI in GCNP visitors, 2) how future HRI rates may change, and 3) how land management agencies can update risk mitigation strategies to match changing risk and better manage an increased HRI burden.

METHODS

We utilized previously published data on HRI in GCNP visitors, and records of daily visitation, temperatures, and maximum and minimum daily humidity from the same study period to develop a model estimate for HRI risk. We then used future climate projections from the World Climate Research Programme's Coupled Model Intercomparison Project phase 5 multi-model dataset to model future HRI risk under different climate scenarios.

RESULTS

The incidence of HRI was significantly associated with maximum daily temperature and minimum relative humidity, and was more common in the shoulder season months. We estimated that HRI will increase 29%-137% over 2004-2009 levels through 2100, assuming no change in visitation.

DISCUSSION

Climate change will continue to increase HRI risk for GCNP visitors and poses risks to public land managers' mission to provide for safe recreation experiences for the benefit of this and future generations in places like GCNP. Excessive risk during the shoulder season months presents an opportunity to increase preventative search and rescue and education efforts to mitigate increased risk.

Environmental Impact of Ambulatory Telehealth Use by a Statewide University Health System During COVID-19

Objective: Several studies before the COVID-19 pandemic documented the positive impact of telehealth on patients' travel distance, time, out-of-pocket costs, and greenhouse gas emissions. The objective of this study was to calculate these outcomes following the increased use of ambulatory telehealth services within five large University of California (UC) health care systems during the COVID-19 pandemic. Methods: We analyzed retrospective ambulatory telehealth data from the five UC health care systems between March 1, 2020, and February 28, 2022. Travel distances and time saved were calculated using the round-trip distance a patient would have traveled for an in-person visit, while cost savings were calculated using Internal Revenue Services' (IRS) 2022 standard mileage reimbursement rates. In addition, we estimated the injuries and fatalities avoided using the national motor vehicle crash data. Greenhouse gas emissions were estimated using the 2021 national average vehicle emission rates. Results: More than 3 million (n = 3,043,369) ambulatory telehealth encounters were included in the study. The total round-trip distance, travel time, and travel cost saved from these encounters were 53,664,391 miles, 1,788,813 h, and $33,540,244, respectively. These translated to 17.6 miles, 35.3 min, and $11.02 per encounter. By using telehealth, 42.4 crash-related injuries and 0.7 fatalities were avoided. The use of telehealth for ambulatory services during this time eliminated 21465.8 metric tons of carbon dioxide, 14.1 metric tons of total hydrocarbons, 212.3 metric tons of exhaust carbon monoxide, and 9.3 metric tons of exhaust nitrogen oxide emissions. Conclusions: Telehealth use for ambulatory services in a statewide academic Health System during COVID-19 had a positive impact on patient travel distance, time and costs, injuries and fatalities in motor vehicle accidents, and greenhouse gas emissions. These significant advantages of telehealth should be considered when planning future health services.

Emerging Pathogen Threats in Transfusion Medicine: Improving Safety and Confidence with Pathogen Reduction Technologies

Emerging infectious disease threats are becoming more frequent due to various social, political, and geographical pressures, including increased human-animal contact, global trade, transportation, and changing climate conditions. Since blood products for transfusion are derived from donated blood from the general population, emerging agents spread by blood contact or the transfusion of blood products are also a potential risk. Blood transfusions are essential in treating patients with anemia, blood loss, and other medical conditions. However, these lifesaving procedures can contribute to infectious disease transmission, particularly to vulnerable populations. New methods have been implemented on a global basis for the prevention of transfusion transmissions via plasma, platelets, and whole blood products. Implementing proactive pathogen reduction methods may reduce the likelihood of disease transmission via blood transfusions, even for newly emerging agents whose transmissibility and susceptibility are still being evaluated as they emerge. In this review, we consider the Mirasol PRT system for blood safety, which is based on a photochemical method involving riboflavin and UV light. We provide examples of how emerging threats, such as Ebola, SARS-CoV-2, hepatitis E, mpox and other agents, have been evaluated in real time regarding effectiveness of this method in reducing the likelihood of disease transmission via transfusions.

The role of policy in supporting environmentally sustainable foodservice in healthcare: lessons from exemplar hospitals

Background

Foodservice in hospitals contributes to the environmental footprint of healthcare delivery. There is little known about the role of policy in supporting environmentally sustainable foodservices. The aim of the study was to explore policy in exemplar environmentally sustainable hospital foodservices from the perspective of hospital staff, toward what makes a policy effective, the limitations of policy, and the influential levels and types of policy.

Methods

A generic qualitative inquiry approach was utilized. Staff involved in foodservices were interviewed about the role of policy during 2020-2021 from 14 hospitals across nine countries. Data were analyzed using framework and thematic analysis.

Results

Policies spanned across high level policies at the level of the healthcare organization, local hospital procedures and protocols, as well as public policy from local, state/provincial and national government. Internal organizational policy was used to embed practices within the organization in the long term and help to build a shared vision and goal where public policy had lacked guidance. The creation, content and methods of communication and creating accountability made internal organizational policy successful. Public policy was most effective when it was mandatory, had clearly defined targets and funding to assist implementation. These exemplar hospitals also demonstrated attributes of policy entrepreneurs by engaging with policy makers to share their stories and lobby government for policy change.

Discussion

Policy from within the healthcare organization is an important mechanism for enabling hospitals to deliver and maintain environmentally sustainable foodservice. Public policy must be designed considering the unique implementation challenges hospitals face to ensure they are successful.

How much bilateral and multilateral climate adaptation finance is targeting the health sector? A scoping review of official development assistance data between 2009-2019

Climate change is adversely affecting human health. Rapid and wide-scale adaptation is urgently needed given the negative impact climate change has across the socio-environmental determinants of health. The mobilisation of climate finance is critical to accelerate adaptation towards a climate resilient health sector. However, a comprehensive understanding of how much bilateral and multilateral climate adaptation financing has been channelled to the health sector is currently missing. Here, we provide a baseline estimate of a decade's worth of international climate adaptation finance for the health sector. We systematically searched international financial reporting databases to analyse 1) the volumes, and geographic targeting, of adaptation finance for the health sector globally between 2009-2019 and 2) the focus of health adaptation projects based on a content analysis of publicly available project documentation. We found that health was largely a co-benefit, not the principal objective, within the projects. We estimate that USD 1,431 million (4.9%) of total multilateral and bilateral adaptation has been committed to health activities across the decade. However, this is likely an overestimate of the true figure. Most health adaptation projects were in Sub-Saharan Africa, with average project funding comparable to East Asia and the Pacific and the MENA region. Fragile and conflict affected countries received 25.7% of total health adaptation financing. The paucity of health indicators as part of project monitoring and evaluation criteria and the lack of emphasis on local adaptation were particularly significant. This study contributes to the wider evidence base on global health adaptation and climate financing by quantifying adaptation funds directed towards the health sector and revealing specific gaps in financing health adaptation. We anticipate these results will support researchers in developing actionable research on health and climate finance and decision-makers in mobilizing funds to low-resource settings with high health sector adaptation needs.