The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms

Patients' Attitudes Towards Integrating Environmental Sustainability Into Healthcare Decision-Making: An Interview Study

INTRODUCTION

The ethical obligation to reduce the environmental impact of healthcare systems prompts an exploration of if and when environmental concerns should be integrated into clinical decision-making. In this study, we aimed to elucidate patients' attitudes regarding the provision of environmental information in healthcare decision-making and to identify preferred approaches for integrating these considerations into patient-provider consultations.

METHODS

This interview study served as an in-depth follow-up of a survey study on gynaecological patients' perspectives on environmental sustainability within healthcare settings. We conducted semistructured interviews with 14 patients from two Dutch outpatient clinics between February and May 2024. We employed reflexive thematic analysis to analyse the data.

RESULTS

Five main themes were developed from the data: (1) Patients are an integral part of the transition to sustainable healthcare, (2) Patients are open to information on environmental impact of healthcare, (3) Information on environmental impact should be tailored to the individual patient and context, (4) Patients vary in preferences for involvement in decision-making related to environmental sustainability and (5) Patients prioritize individual health over environmental concerns in healthcare decision-making.

CONCLUSION

The findings of our study underscore the importance of integrating sustainability into clinical decision-making, aligning with bioethical principles and the expectations and goals of patients. By ensuring that environmental considerations are introduced in a personalized and context-appropriate manner within patient-provider interactions, healthcare can foster greater support for sustainable practices.

PATIENT OR PUBLIC CONTRIBUTION

Patients were involved in developing the pre-interview questionnaire. The preliminary results of the study were presented to healthcare professionals from various backgrounds during a meeting of the Dutch Green Care Alliance, after which the input was incorporated into the interpretation of the study results. Finally, the complete manuscript was presented to representatives from the Dutch Patient Federation to obtain their input on the interpretation and implications of our research. The interpretation of our results aligned with the findings from their recent national inquiries, which included data from over 9300 patients within their network. Consequently, no changes were made to the manuscript's discussion.

The climate crisis - actions to prioritize for anaesthesiologists

PURPOSE OF REVIEW

Climate change is the biggest threat to human health and survival in the twenty-first century. Emissions associated with healthcare contribute to climate change and there are many personal and professional actions that can reduce carbon emissions. This review highlights why action is necessary and what anaesthetists and healthcare workers can do.

RECENT FINDINGS

Encouraging continuing research regarding sustainable anaesthesia and expanding education at all levels to include climate action is key. Professionally, actions include limiting use of single-use equipment, reducing reliance on volatile gas inhalational anaesthesia, and adopting low fresh gas flow techniques. Personal actions such as climate-conscious travelling, spending, and eating are important, especially when shared to create climate positive movements.

SUMMARY

This article shows that, while patient safety and quality of care must remain healthcare's top priority, considering the climate implications of care is part of that duty. Many actions that reduce the carbon impact of care simultaneously improve the quality of care and reduce financial cost. More research into sustainable healthcare is needed. Departments and hospitals and must create environments in which climate conversations are welcomed and can result in positive advancements.

Continuous Core Body Temperature Monitoring for Heatstroke Alert via a Wearable In-Ear Thermometer

Heatstroke, a global concern exacerbated by climate change, poses significant health risks, potentially leading to multiorgan damage and fatalities. Core body temperature (CBT) is a critical and precise indicator of heatstroke, and its continuous monitoring could serve as a pivotal tool for early detection. Traditional CBT measurements, often invasive (e.g., surgical intubation, rectal or oral placement), and disrupt daily activities, whereas existing wearable devices predominantly measure skin temperatures which is susceptible to ambient environment, thus unreliable for heatstroke alert. To overcome these limitations, this study introduces an innovative in-ear wearable device to measure CBT via the cochlea, which allows for accurate CBT monitoring and timely heatstroke alerts during activities in high-temperature and high-humidity environments. The device comprises a negative temperature coefficient (NTC) thermometer integrated into a flexible precision circuit (FPC), a compact Bluetooth module, an 8 mA h micro battery, and a biocompatible, low-stimulus silica gel casing. With dimensions of 27 mm × 18 mm and a maximum in-ear diameter of 5 mm, weighing just 1.3 g, the device offers high portability and comfort, with a continuous operational lifespan of at least 24 h postcharging. A complementary software system facilitates continuous CBT monitoring, heatstroke alerts, and device management. Preliminary human trials demonstrate the device's accuracy in CBT measurement, rivaling that of rectal thermometry, and superior to the performance of surface body temperature measurement at different body parts. Long-term experiments affirm the device's efficacy in detecting rapid CBT escalations, enabling timely preventive measures against heatstroke.

Imperatives and co-benefits of research into climate change and neurological disease

Evidence suggests that anthropogenic climate change is accelerating and is affecting human health globally. Despite urgent calls to address health effects in the context of the additional challenges of environmental degradation, biodiversity loss and ageing populations, the effects of climate change on specific health conditions are still poorly understood. Neurological diseases contribute substantially to the global burden of disease, and the possible direct and indirect consequences of climate change for people with these conditions are a cause for concern. Unaccustomed temperature extremes can impair the systems of resilience of the brain, thereby exacerbating or increasing susceptibility to neurological disease. In this Perspective, we explore how changing weather patterns resulting from climate change affect sleep - an essential restorative human brain activity, the quality of which is important for people with neurological diseases. We also consider the pervasive and complex influences of climate change on two common neurological conditions: stroke and epilepsy. We highlight the urgent need for research into the mechanisms underlying the effects of climate change on the brain in health and disease. We also discuss how neurologists can respond constructively to the climate crisis by raising awareness and promoting mitigation measures and research - actions that will bring widespread co-benefits.

Scoping review of the societal impacts of compound climate events

Climatic extremes have historically been seen as univariate; however, recent international reports have highlighted the potential for an increase in compound climate events (e.g., hot and dry events, recurrent flooding). Despite the projected increase in the frequency of compound climate events and the adoption of compound event terminology, few studies identify climate extremes as compound climate events and little evidence exists on the societal impacts of these compound climate events. This scoping review summarizes key findings and knowledge gaps in the current state of empirical studies that focus on the societal impacts of compound climate events. We identified 28 eligible studies published in four databases reporting on the societal impacts of compound climate events in four sectors: agriculture, public health, the built environment, and land use. Overall, we found the need for more research explicitly linking compound climate events to societal impacts, particularly across multiple compound climate events, rather than single case study events. We also noted several key findings, including changes in agricultural productivity, loss of habitat, increased fire risk, poor mental health outcomes, decreased health care access, and destruction of homes and infrastructure from these events. Additional research is needed both globally and locally to understand the implications of compound climate events across different geographic regions and populations to ensure responsive adaptation policies in a compound climate event framework.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44274-025-00185-y.

Mice develop obesity and lose myocardial metabolic flexibility months after exertional heat stroke

As global temperatures rise, heat-related chronic health disorders are predicted to become more prevalent. We tested whether a single exposure to acute heat illness, using a preclinical mouse model of exertional heat stroke (EHS), can induce late-emerging health disorders that progress into chronic disease. Following EHS, mice were followed for 3 months; after two weeks of recovery, half were placed on a Western diet to determine if previous EHS exposure amplifies the negative consequences of an atherogenic diet. When compared to sham exercise controls, EHS-exposed mice exhibit accelerated diet-induced obesity, develop low level cardiac hypertrophy, develop accelerated diet-induced liver steatosis, severe hypoproteinemia and a loss of metabolic flexibility in the myocardium. The latter is characterized by a shift towards predominant glucose metabolism and glycolysis. These results demonstrate that a single exposure to severe exertional heat illness can induce long-lasting and unexpected health consequences in mammals and increased vulnerability to secondary metabolic stressors.

Global surgery and climate change: how global surgery can prioritise both the health of the planet and its people

Climate change is an emerging global health crisis, disproportionately affecting low- and middle-income countries (LMICs) where health outcomes are increasingly compromised by environmental stressors such as pollution, natural disasters, and human migration. With a focus on promoting health equity, Global Surgery advocates for expanding access to surgical care and enhancing health outcomes, particularly in resource-limited and disaster-affected areas like LMICs. The healthcare industry-and more specifically, surgical care-significantly contributes to the global carbon footprint, primarily through resource-intensive settings, i.e. operating rooms that generate greenhouse gases and substantial medical waste. Therefore, Global Surgery efforts aimed at improving surgical access through an increase in surgical volumes may inadvertently exacerbate health challenges for vulnerable populations by further contributing to environmental degradation. This predicament is particularly pronounced in LMICs, who already suffer from a disproportionate share of the global burden of disease, and where the demand for surgery is rising without corresponding resilient infrastructure. LMICs face a double jeopardy of health inequity coupled with climate vulnerability. As a movement positioned to improve health around the world, Global Surgery has an increasingly significant role in envisioning and ensuring a sustainable future. Global Surgery initiatives must prioritise sustainable infrastructure in both high-income countries (HICs) and LMICs, all while accounting for the unequal polluting contributions between HICs and LMICs and, consequently, moral responsibilities moving forward. Moreover, through targeting upstream causes of poor health at urban and perioperative levels, Global Surgery's interventions may help to reduce the global burden of disease-avoiding preventable surgeries and their carbon footprints from the outset. Altogether, Global Surgery and climate change are two matters of social justice whose solutions must synergistically centralise the health of both the planet and its most vulnerable people.

Introducing the Next Era in Assessment

In this introduction, the guest editors of the "Next Era in Assessment" special collection frame the invited papers by envisioning a next era in assessment of medical education, based on ideas developed during a summit that convened professional and educational leaders and scholars. The authors posit that the next era of assessment will focus unambiguously on serving patients and the health of society, reflect its sociocultural context, and support learners' longitudinal growth and development. As such, assessment will be characterized as transformational, development-oriented and socially accountable. The authors introduce the papers in this special collection, which represent elements of a roadmap towards the next era in assessment by exploring several foundational considerations that will make the next era successful. These include the equally important issues of (1) focusing on accountability, trust and power in assessment, (2) addressing implementation and contextualization of assessment systems, (3) optimizing the use of technology in assessment, (4) establishing infrastructure for data sharing and data storage, (5) developing a vocabulary around emerging sources of assessment data, and (6) reconceptualizing validity around patient care and learner equity. Attending to these priority areas will help leaders create authentic assessment systems that are responsive to learners' and society's needs, while reaping the full promise of competency-based medical education (CBME) as well as emerging data science and artificial intelligence technologies.

The combined effects of sleep and extreme heat exposure on cognitive function among older adults

BACKGROUND

Extreme heat is linked to cognitive impairment. Normal sleep duration and good sleep quality can reduce cognitive impairment risks. However, the combined impact of sleep (duration and quality) and extreme heat on cognitive impairment is unclear. This study tests whether normal sleep duration and good sleep quality during a heatwave reduce cognitive impairment compared to poor sleep quality and long sleep duration in older adults.

METHODS

This study used cohort data from 9153 older adults. Extreme heat was defined as periods ≥ 3 days with daily minimum temperatures above the 92.5th percentile during the warm season. Cognitive function was assessed with the Mini-Mental State Examination (MMSE). Sleep duration was categorized as long, normal, or short, and sleep quality as good or poor. Six and four categories were used for combinations of heatwave exposure with sleep duration and quality, respectively. Cox regression models were applied for analysis.

RESULTS

Compared to those with long sleep duration during heatwaves, participants exposed to heatwaves with normal sleep duration had lower cognitive impairment risk (HR: 0.86, 95 %CI: 0.76-0.97). Those exposed to extreme heat with short sleep duration also showed lower cognitive risks (HR: 0.74, 95 %CI: 0.62-0.88). Compared to those with poor sleep quality during heatwave, participants with good sleep quality during heatwaves did not show significantly lower cognitive impairment risk (HR: 1.10, 95 %CI: 0.98-1.23).

CONCLUSION

Older adults with normal or short sleep duration during heatwaves may face lower cognitive impairment risks, highlighting the importance of sleep guidance to protect cognitive health during extreme heat.

Factors influencing changes in the quality of life of the Hainan migratory population with hypertension: a survey of the Chengmai mangrove bay community

BACKGROUND

Hainan is a tropical island in China with a large migratory population. Study have reported that the blood pressure of Hainan elderly hypertensive migratory population decreased significantly, which may be related to the improvement of environment and quality of life (QoL). Understanding the changes of QoL of these people before and after coming to Hainan and its influencing factors can provide a basis for the prevention and control of hypertension.

METHODS

A cross-sectional study of elderly hypertensive migratory population were conducted in Chengmai Mangrove Bay community of Hainan from December 2021 to January 2022. Convenience sampling was used to recruit elderly hypertensive migratory individuals reside stay of longer than one month. After obtaining informed consent, we investigated the demographic characteristics of the participants and evaluated their QoL with the SF-36 twice; one round of the SF-36 was about their hometown, and the other round was about living in Hainan for 1 month. The Cronbach's α coefficient and KMO value of SF-36 were both greater than 0.8, indicating good reliability and validity. The difference in blood pressure between that observed in Hainan and that observed in their hometowns was used to determine whether the Body Pain change in the subjects decreased or did not decrease after migrating to Hainan. Univariate analysis was performed via paired t tests and Kendall's tau-b tests, and multiple linear regression analysis and logistic regression analysis were used to analyse the factors influencing the QoL of the participants.

RESULTS

A total of 305 hypertensive migratory individuals participated in this study. Among them, there were 148 males (48.52%) and 157 females (51.48%), with a mean age of 68.61 ± 9.39 years. The postmigration scores for the 8 subscales of QoL, the global score, the Physical Component Score, and the Mental Component Score were all higher than the scores for their hometowns (P < 0.05). Factors such as gender (r = 0.139, P < 0.05), age (r = 0.209, P < 0.05), and level of education (r=-0.133, P < 0.05) were associated with changes in the QoL of the participants. The conditions of green and water spaces in their hometown, sleep habits in their hometown and ventilation habits in their hometown were the major factors influencing the subjects' QoL in their hometown (P < 0.05). The factors that influenced the improvement in the subjects' QoL in Hainan included hypertension classification (OR = 2.336, 95% CI: 1.125 ∼ 4.853, P = 0.023) and BMI (OR = 6.402, 95% CI: 1.009 ∼ 40.624, P = 0.049).

CONCLUSION

The QoL of hypertensive migratory population in Hainan improved with respect to individual health, physiological function, psychological function and social function. The lower the hypertension classification and BMI are, the greater the improvement in the QoL of hypertensive migratory population.

Integrating human biomonitoring exposure data into a primary care morbidity database: a feasibility study

BACKGROUND

The detection of a local per- and polyfluoroalkyl substances (PFAS) pollution hotspot in Zwijndrecht (Belgium) necessitated immediate action to address health concerns of the local community. Several human biomonitoring (HBM) studies were initiated, gathering cross-sectional exposure data from more than 10,000 participants. The linkage of these HBM data with primary care health registries might be a useful new tool in environmental health analysis.

AIM

We assessed the feasibility of linking exposure data from HBM programs to health outcomes from the Intego registry, which collects data from general practitioners' electronic health records. This feasibility study uses exposure data from one of the completed PFAS HBM studies, which included 796 individuals. We describe the separate datasets, the process of integrating the HBM data into Intego, the analysis plan and the advantages and challenges of using this method.

RESULTS

We established the integration of HBM data into the Intego primary care morbidity database, adhering to stringent privacy regulations and quality standards to ensure result integrity. Because of the modest sample size used in this feasibility study, no conclusions about the impact of PFAS on health endpoints can be drawn. However, with PFAS data from more than 10,000 residents available soon, more robust studies will be possible with this new method.

INTERPRETATION

We introduce a novel approach for assessing the impact of environmental health hazards within primary care settings. The methods outlined here not only pave the way for larger-scale projects but also offer a promising avenue for long-term environmental health monitoring.

World Stroke Organization: Global Stroke Fact Sheet 2025

BACKGROUND

Among non-communicable disorders (NCDs), stroke remains the second leading cause of death and the third leading cause of death and disability combined (as expressed by disability-adjusted life-years lost-DALYs) in the world.

AIMS

The study was aimed to estimate global, regional and nationa burden of stroke and its risk factors from 1990 to 2021.

METHODS

Finding presented in this paper were derived mainly from the Global Burden of Disease 2021 Study on stroke burden published in The Lancet Neurology 2024:23:973-1003.

RESULTS

The estimated global cost of stroke is over US$890 billion (0.66% of the global GDP). From 1990 to 2021, the burden (in terms of the absolute number of cases) increased substantially (70.0% increase in incident strokes, 44.0% deaths from stroke, 86.0% prevalent strokes, and 32% DALYs), with the bulk of the global stroke burden (87.0% of deaths and 89.0% of DALYs) residing in lower-income and lower-middle-income countries (LMICs). Stroke attributable to metabolic risks constituted 69.0% of all strokes, environmental risks constituted 37.0%, and behavioral risks constituted 35.0%.

CONCLUSION

This World Stroke Organization (WSO) Global Stroke Fact Sheet 2025 provides the most updated information that can be used to inform communication with all internal and external stakeholders; all statistics have been reviewed and approved for use by the WSO Executive Committee and leaders from the Global Burden of Disease research group.

Projecting the overall heat-related health burden and associated economic costs in a climate change context in Quebec, Canada

Extreme heat represents a major health risk for the world's population, that is amplified by climate change. However, the health costs associated with these heat events have only been little studied. To stimulate the implementation of effective interventions against extreme heat, a more comprehensive economic valuation of these health impacts is crucial. In this study, a general framework for assessing historical and projected heat-related health costs is presented and then applied to the province of Quebec (Canada). First, heat-related mortality and morbidity, as well as the number of extreme heatwaves, were computed for a historical (∼2000) and projected (∼2050) period under two shared socioeconomic pathways (SSP). Then, these heat-related numbers were converted into 1) direct healthcare costs, 2) indirect productivity costs and 3) intangible societal costs, using the best available cost information. Results showed that historical heat-related health costs were respectively 15M$, 5M$ and 3.6G$ (in 2019 Canadian dollars) annually for the direct, indirect and intangible components in Quebec, Canada. Under a middle-of-the-road scenario (SSP2-4.5), there was a 3-fold increase in total costs due to climate and population change (10.9G$ annually), while under a pessimistic scenario (SSP5-8.5), the increase was 5-fold (17.4G$). Total costs were mostly driven by intangible impacts, such as loss of life (∼90-95%) and of well-being during heatwaves (∼5-10%). Given that heat-related health costs are already significant, and likely to increase substantially in the future, this study has demonstrated the vital need to reduce its burden now and in the future by adopting more measures to mitigate climate change and adapt to heat.

Application of multi-angle spaceborne observations in characterizing the long-term particulate organic carbon pollution in China

Ambient PM2.5 pollution poses a major risk to public health in China, contributing to significant mortality and morbidity. While overall PM2.5 concentrations have declined in recent years, the changes in PM2.5 chemical constituents remain inadequately understood due to limited ground monitoring networks. We developed a Super Learner model that integrates MISR satellite data, chemistry transport model simulations, and land use information to predict daily OC concentrations across China from 2003 to 2019 at a 10-km spatial resolution. The model achieved high predictive accuracy with a cross-validation R2 of 0.84 and an RMSE of 4.9 μg/m3. Our findings show elevated OC levels in Northern China, driven by industrial activities with concentrations exceeding 30 μg/m3 during the heating season. In contrast, forest fires were the primary contributors in Yunnan, raising OC concentrations to 20-30 μg/m3 during fire seasons. Over the 17-year period, the national OC trend declined by 1.3 % annually. Regionally, the Beijing-Tianjin-Hebei region and the Fenwei Plain experienced faster reductions at annual rates of 1.5 % and 2.0 %, respectively, while Yunnan exhibited no significant trends. To better understand pollution source contributions, we analyzed the OC/EC ratio, which indicated higher ratios in less populated rural areas, suggesting agricultural and biogenic emissions, while lower ratios in urban clusters pointed to primary sources such as traffic and industrial activities. Notably, since 2013, significant decreases in the OC/EC ratio have been observed in the North China Plain, likely reflecting the impact of stringent air pollution control policies on biomass burning. This study provides valuable exposure estimates for epidemiological research on the long-term health effects of OC in China, offering insights for evaluating air quality policies and guiding future management strategies.

Health status and heat preparation at a UCI World Tour multistage cycling race

OBJECTIVES

To assess health status and heat preparation of cyclists at the 2019 Tour Down Under and determine the alignment of heat mitigation strategies with current recommendations.

DESIGN

Cohort study.

METHODS

Twenty-three (17 % participation rate) male World Tour cyclists from five teams and 10 countries completed a pre-competition questionnaire evaluating exertional heat illness (EHI) history, pre-race health status, and heat mitigation and recovery strategies use. Associations between arrival days pre-competition, years as professional, nationality, team, history of EHI symptoms and diagnosis on heat mitigation and recovery strategy utilisation were assessed.

RESULTS

65 % of cyclists reported previously experiencing one or more EHI symptom (cramping: 48 %) and 22 % a diagnosis of heat stroke. In the 10 days preceding the race, 26 % experienced one or more illness symptoms. 65 % trained in the heat (acclimatisation 8-25 days; acclimation: 3-7 days), which was associated with team (P = 0.047, ϕc = 0.61), nationality (P = 0.009, ϕc = 0.86) and EHI symptoms history (P = 0.058, ϕ = 0.43). All cyclists had a hydration plan, with links to team (0.5-1.0 L·h-1, P = 0.043, ϕc = 0.68) and EHI symptom history (1.0-1.5 L·h-1, P = 0.048, ϕ = 0.476). Most had pre-cooling (87 %) and mid-cooling (83 %) strategies, most commonly cold beverages (75 %) and neck collars (78 %), respectively. All cyclists planned on using at least one recovery strategy (massage: 87 %).

CONCLUSIONS

Our data indicate good alignment with current recommendations for competing in the heat, particularly for hydration, cooling and recovery strategies. Whilst the proportion of cyclists engaging in heat acclimation/acclimatisation is encouraging, greater awareness on adapting and implementing heat training is required.

Interactive Effects of Long-term Exposure to Air Pollutants on SARS-CoV-2 Infection and Severity: A Northern Italian Population-based Cohort Study

BACKGROUND

We examined interactions, to our knowledge not yet explored, between long-term exposures to particulate matter (PM 10 ) with nitrogen dioxide (NO 2 ) and ozone (O 3 ) on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectivity and severity.

METHODS

We followed 709,864 adult residents of Varese Province from 1 February 2020 until the first positive test, COVID-19 hospitalization, or death, up to 31 December 2020. We estimated residential annual means of PM 10 , NO 2 , and O 3 in 2019 from chemical transport and random-forest models. We estimated the interactive effects of pollutants with urbanicity on SARS-CoV-2 infectivity, hospitalization, and mortality endpoints using Cox regression models adjusted for socio-demographic factors and comorbidities, and additional cases due to interactions using Poisson models.

RESULTS

In total 41,065 individuals were infected, 5203 were hospitalized and 1543 died from COVID-19 during follow-up. Mean PM 10 was 1.6 times higher and NO 2 2.6 times higher than WHO limits, with wide gradients between urban and nonurban areas. PM 10 and NO 2 were positively associated with SARS-CoV-2 infectivity and mortality, and PM 10 with hospitalizations in urban areas. Interaction analyses estimated that the effect of PM 10 (per 3.5 µg/m 3 ) on infectivity was strongest in urban areas [hazard ratio (HR) = 1.12; 95% CI =1.09, 1.16], corresponding to 854 additional cases per 100,000 person-years, and in areas at high NO 2 co-exposure (HR = 1.15; 1.08, 1.22). At higher levels of PM 10 co-exposure, the protective association of O 3 reversed (HR =1.32, 1.17, 1.49), yielding 278 additional cases per µg/m 3 increase in O 3 . We estimated similar interactive effects for severity endpoints.

CONCLUSIONS

We estimate that interactive effects between pollutants exacerbated the burden of the SARS-CoV-2 pandemic in urban areas.

Responding to the Impact of Climate Change on Adolescent and Young Adult Health: A Position Paper of the Society for Adolescent Health and Medicine and the International Association for Adolescent Health

The Society for Adolescent Health and Medicine and the International Association for Adolescent Health recognize that climate change impacts multiple dimensions of health and well-being for adolescents and young adults. According to the World Health Organization, climate change is one of the top 10 health threats facing humanity. No aspect of adolescent health is spared from the consequences of climate change: food and housing insecurity, heat-related morbidity and mortality, water-borne diseases, infectious diseases, including sexually transmitted infections and HIV, mental health disorders, gender-based violence, conflict, internal displacement, and migration are all impacted. Vulnerable populations, such as adolescents and young adults, and those living in lower- to middle-income countries and environmental justice communities, are the ones whose health will be most affected. The Society for Adolescent Health and Medicine and the International Association for Adolescent Health call for urgent action in alignment with the United Nations Sustainable Development Goals and the Convention on the Rights of the Child to avert the irreversible consequences of climate change. Health professionals and health-care organizations can and should help lead global climate action along with youth, supporting mitigation and adaptation strategies that protect young people. Adolescent health professionals and organizations must advocate for climate justice and equitable resources, urge health systems to mitigate their adverse impacts on the environment, advocate for health organizations to focus on green investments, be leaders in climate education of the next generation of adolescent health professionals, and focus research on equitable strategies to reduce climate harms.

The Effect of Climate Change on Allergen and Irritant Exposure

As the effects of anthropogenic climate change have become more apparent, the influences of climate and extreme weather events on health have continued to gain attention. The fact Earth has warmed over the past century is indisputable and the rate of warming is more alarming. As a result of anthropogenic climate change, an alteration in the air mixture has occurred over time. These changes have increased human exposures to respiratory irritants such as ground-level ozone, volatile organic compounds, nitrogen dioxide, sulfur dioxide, carbon monoxide, and polycyclic aromatic hydrocarbons. A significant amount of research has investigated the effects of climate change on aeroallergens, which has shown that elevated temperatures and increased carbon dioxide levels have produced prolonged and more robust pollen seasons for most taxa studied. In addition, it appears possible that exposure of some plants to air pollution may result in more allergenic pollen. Increased human exposures to these respiratory irritants and aeroallergens appears to disproportionality effect vulnerable populations throughout the world. It is essential to understand that climate change is more than an environmental inconvenience and realize the effects to human health are directly related and conceivably immeasurable. It is vital to conduct additional research related to climate change and health that is collaborative, multisectoral, and transdisciplinary. There should be a focus on risk reduction, mitigation, and preparedness for climate change and extreme weather events for all populations around the globe.

Primary healthcare's carbon footprint and sustainable strategies to mitigate its contribution: a scoping review

BACKGROUND

The escalating climate crisis poses a significant threat to global public health. The healthcare sector, designed to protect human health is a major contributor to greenhouse gas emissions, and thus, a key driver of climate degradation. This paradox endangers both planetary and human health, making the decarbonization of healthcare, including primary care, critical. However, research on primary care's contribution to emissions and strategies for mitigation remains limited.

AIM

This scoping review aimed to map how primary care contributes to healthcare's environmental footprint and determine contributing factors. Additionally, it sought to identify existing and innovative strategies to reduce the carbon footprint of primary healthcare.

METHODS

A comprehensive strategy was developed to systematically search both published databases and grey literature. Key terms were identified and employed in the exploration of relevant databases and internet search engines.

RESULTS

An initial search yielded 246 published articles and 25 grey literature sources. 14 additional articles were included following forward and backward searching of prominent authors and key articles. After screening and full-text review, 39 articles and 12 reports/toolkits were included. The majority of sources were opinion pieces, with limited quantitative, observational, or qualitative studies. Primary care's carbon footprint can be classified into clinical and non-clinical sources, with significant impacts from pharmaceuticals and inhaler propellant gases. Contributing factors include limited knowledge of emission sources, lack of awareness of sustainable practices, low prioritization of sustainability, barriers including ethical concerns and over-medicalization. Identified strategies to reduce emissions include decarbonization of patient care, increasing education and awareness, implementing non-clinical decarbonization efforts, and conducting more research to support sustainable initiatives. Developing metrics to track progress and securing policy supports to improve adoption and implementation were also highlighted as critical.

CONCLUSION

The identification of sources of carbon hotspots in primary care is an essential precursor to enable the development of targeted decarbonization strategies. Decarbonizing primary care requires a multifaceted approach that addresses the underlying factors driving unsustainable practices. This would allow healthcare professionals to effectively balance the provision of high-quality patient care, while reducing their environmental impact, ultimately improving both human and planetary health.

Association between increase in temperature due to climate change and depressive symptoms in Korea

BACKGROUND

Studies on the long-term effects of rising temperature by climate change on mental health are limited. This study investigates the influence of temperature rise on the prevalence rate of depressive symptoms according to district type and age group in Korea.

DESIGN

This cross-sectional study included 219,187 Korea Community Health Survey 2021 participants. Yearly average temperature and yearly average temperature difference are the main exposures of this study. Temperature difference was calculated by subtracting the historical average temperature in 1961-1990 (climate normal) from the yearly average temperature. The main outcomes are moderate depressive symptoms measured by Patient Health Questionnaire-9. Multilevel analyses were conducted to estimate the association between temperature factors and depressive symptoms.

RESULTS

7491 (3.4 %) participants reported moderate depressive symptoms, and 99,653 (69.9 %) participants lived in an urban district. The odds of depressive symptoms increased with 1 °C increase in temperature difference for all participants, adult participants aged 19-40, and participants who lived in same metropolitan area for 20 years or more (aOR = 1.13, CI: 1.04-1.24, aOR = 1.14, CI: 1.02-1.24, and aOR = 1.15 CI: 1.04-1.27). The association between temperature difference and depressive symptoms was consistent among urban districts participants.

LIMITATIONS

Due to the study's cross-sectional nature, the temporal association between regional and individual factors and depressive symptoms could not be assessed. Limited number of weather stations, especially among less populated in-land areas, may limit the accuracy of this study.

CONCLUSION

The increase in temperature compared with historical average is associated with increased likelihood of depressive symptoms, especially for the adults aged 19-40 years old. More study on the long-term impact of climate change on mental health is needed to determine effective responses to climate change.

Mortality and morbidity risks associated with floods: A systematic review and meta-analysis

BACKGROUND

Flood disasters are projected to increase in severity, duration, and frequency in the context of climate change, and the risks of mortality and morbidity may increase after floods, which will overwhelm health systems.

OBJECTIVE

This study aims to synthesize current epidemiological evidence about the impacts of floods on mortality and morbidity.

METHOD

After performing a systematic literature search from 2000 to 2023, we included studies involving human participants, with exposures of floods, and with outcomes of mortality or morbidity.

RESULTS

In total, 37 studies were included in evidence syntheses. Meta-analyses yielded an overall relative risk of 1.26 (95% confidence interval [CI]: 1.10, 1.46), 1.10 (1.08, 1.13), 1.11 (1.04, 1.20), and 1.38 (1.18, 1.62) for all-cause mortality and morbidities of overall gastrointestinal diseases, diarrhea diseases, and dysentery, respectively. Although meta-analyses were not conducted, evidence from at least three studies consistently supported that exposure to floods was associated with increased risks of malaria and respiratory diseases. The evidence for other outcomes was reported but either limited or uncertain.

CONCLUSION

This study suggests that exposure to floods is associated with increased risks of all-cause mortality and morbidities of overall gastrointestinal diseases, diarrhea diseases, dysentery, malaria, and respiratory diseases, while further research is urgently called.

Longitudinal determinants of thriving in Puerto Rican climate crisis migrants on the U.S. mainland: A structural equation model

Climate-related disasters pose significant risks to mental health and well-being globally. Individuals from disaster-prone regions, such as Puerto Rico, are at even greater risk. The devastating effects of recurrent hurricanes, compounded with pre-existing structural disparities (e.g., poverty and corruption), can further exacerbate psychosocial vulnerabilities and drive mass migration to the United States mainland. Most research on mental health among climate migrants focuses on risks, whereas promotive factors such as thriving are often overlooked. In the present study, we estimated a longitudinal structural equation model to examine the predictive effect of psychological thriving (i.e., optimism, life satisfaction) on sociocultural thriving (i.e., income, happiness, comfort, job satisfaction), mental distress (i.e., internalizing symptoms, post-traumatic stress) and cultural stressors using three waves of data from 319 adult Hurricane Maria survivor migrants (HMSMs) who relocated to the U.S. mainland between 2017 and 2020. We also examined the mediating effect of prosocial behavior and collective efficacy in this association. Our findings indicate various direct, simple mediation, and serial mediation paths between baseline psychological thriving and outcomes. Life satisfaction and collective efficacy mediated most of the predicted indirect pathways. These results suggest that, despite facing complex challenges, HMSMs are not only adapting to their mainland communities but are also thriving.

Imperative for a health-centred focus on climate change in radiology

Climate change negatively impacts individual and population-level health through multiple pathways, including poor air quality, extreme heat and changes in infectious disease. These health effects will lead to higher health system and medical imaging utilisation. At the same time, the delivery of radiology services generates substantial greenhouse gas emissions. Mitigation strategies to reduce the environmental impact of medical imaging and adaptation strategies to build resiliency to current and future impacts of climate change in radiology should be centred on human health. A health-centred response in radiology reinforces the role of radiologists as physicians and emphasises the opportunity for medical imaging to promote health and advance our understanding of climate-related health effects. This review discusses the need for a health-centred focus on climate change in radiology, including the effects of climate change on human health and health systems, intersection of climate change with health equity, health benefits of climate action and opportunities to leverage medical imaging to improve human health.

Novel Method for Measuring Ambient Heat Exposure-Acute Healthcare Utilization Associations Within a Safety Net: A Retrospective, Longitudinal Study

BACKGROUND

Extreme and inequitable heat exposures cause weather-related deaths. Associations between maximum daily temperature and individual-level healthcare utilization have been inadequately characterized.

OBJECTIVE

To evaluate and compare demographic and clinical associations for an individual's healthcare utilization between high- and low-temperature periods.

DESIGN

Retrospective, 5-year longitudinal study of acute care utilization comparing high-temperature periods (HHP) and low-temperature periods (LHP) defined by local maximum daily temperature. Using duration of observation, cases served as their own controls. Temperature-dependent utilization was reported as unadjusted incident rate ratio (IRR) using Poisson regression and log-transformed variable coefficients. IRRs were adjusted (aIRR) for demographic characteristics, heat-sensitive conditions/diagnoses, and neighborhood heat vulnerability score; false discovery rate p-values were adjusted for multiple comparisons.

SUBJECTS

Patients aged ≥ 4 years visiting Denver Health between 4/10/2016 and 12/31/2020, with ≥ 2 visits over ≥ 365 days.

MAIN MEASURES

Comparison of an individual's acute care visit rates in HHP versus LHP, stratified by demographic characteristics and heat-sensitive clinical conditions.

KEY RESULTS

While acute care utilization occurred at similar or higher rates during LHP compared with HHP, certain groups (i.e., Native Americans and those with congestive heart failure, liver failure, and/or alcohol use) had higher rates of utilization during HHP. Significant associations existed for acute care utilization by age, sex, racial and ethnic groupings, clinical characteristics, and neighborhood heat vulnerability. Adjusting for demographic and environmental covariates, individuals with any heat-sensitive clinical condition had higher HHP vs LHP utilization compared to those without (aIRR = 1.93).

CONCLUSIONS

Significant heat-related utilization occurred among individuals with heat-sensitive clinical conditions compared with those without. Demographic characteristics (e.g., older) and specific clinical conditions (e.g., liver failure) demonstrated higher utilization. In real-time, chronic disease management programs could proactively identify at-risk individuals for interventions which reduce heat-related morbidity and healthcare utilization.

Co-developing frameworks towards environmentally directed pharmaceutical prescribing in Scotland - A mixed methods study

The presence of human pharmaceuticals in the aquatic environment is recognised internationally as an important public health and environmental issue. In Scotland, healthcare sustainability targets call for improvements to medicine prescribing and use to reduce healthcare's impact on the environment. This proof-of-concept study aimed to develop a framework on the environmental impact of pharmaceuticals to use as a knowledge support tool for healthcare professionals, focussing on pharmaceutical pollution. Nominal Group Technique was applied to achieve consensus on pharmaceuticals and modelling factors for the framework, working with a panel of cross-sector stakeholders. Bayesian Belief Network modelling was applied to predict the environmental impact (calculated from hazard and exposure factors) of selected pharmaceuticals, with Scotland-wide mapping for visualisation in freshwater catchments. The model calculated the pollution risk score of the individual pharmaceuticals, using the ratio of prescribed mass vs. mass that would not exceed the predicted no-effect concentration in the freshwater environment. The pharmaceuticals exhibited different risk patterns, and spatial variation of risk was evident (generally related to population density), with the most catchments predicted to exceed the pollution risk score for clarithromycin (probability >80 % in 35 of 40 modelled catchments). Simulated risk scores were compared against observed risk calculated as the ratio of measured environmental concentrations from national regulatory and research monitoring and predicted no-effect concentrations. The model generally overpredicted risk, likely due to missing factors (e.g. solid-phase sorption, temporal variation), low spatial resolution, and low temporal resolution of the monitoring data. This work demonstrates a novel, trans-disciplinary approach to develop tools aiding collation and integration of environmental information into healthcare decision-making, through application of public health, environmental science, and health services research methods. Future work will refine the framework with additional clinical and environmental factors to improve model performance, and develop electronic interfaces to communicate environmental information to healthcare professionals.

Point-of-care ultrasound use in austere environments: A scoping review

BACKGROUND/OBJECTIVES

Technological developments in point-of-care ultrasound (POCUS), particularly with portable devices, are transforming POCUS use in austere, resource-limited environments (RLS) distinct from typical hospital or medical settings. POCUS has potential to improve diagnostic accuracy in military combat zones, low-resource environments such as the desert or tropics, microgravity, and high altitudes. Our updated narrative scoping review describes POCUS use in these global settings.

METHODS

Using the PRISMA-ScR guidelines, two ultrasound-trained emergency physicians searched PubMed, Embase, and Web of Science on August 6, 2024 for "point-of-care ultrasound in austere environments" and each individual category. Study titles and abstracts were independently screened, then full manuscripts, and data was abstracted with a data collection table. 324 articles met inclusion criteria: research studies describing POCUS in austere environments; involving healthcare professionals; and in English. We excluded abstracts, studies not involving POCUS in austere environments, and non-clinical studies. Reviewers critically appraised studies using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) Quality Assessment Tool.

RESULTS

There were 39 military or conflict zone studies, 101 prehospital, 148 in RLS including low- and middle-income countries, 12 outer space, 15 high altitude, and 32 involving POCUS use in multiple austere environments. There were 6 randomized-control trials, 11 systematic/scoping reviews, 13 narrative reviews, 112 prospective observational/cohort, 34 prospective cross-sectional studies, 23 retrospective, 6 feasibility, 45 case reports, 13 case series, and 5 educational curriculum studies. GRADE study quality was variable, with 74 high quality, 129 moderate, 82 low, and 56 very low.

CONCLUSION

The existing literature is mixed with variability in study settings, design, and POCUS examination types, providing an initial understanding of POCUS applications. Most studies are in RLS or prehospital settings. Additional high-quality studies are needed to guide POCUS training, disseminate use in non-hospital settings, and maximize impact for improved clinical outcomes in diverse austere environments.

Ecological preferences and patient autonomy

Healthcare systems contribute considerably to worldwide carbon emissions and therefore reinforce the negative health impacts of climate change. Significant attempts to reduce emissions have been made on the macro level of politics and on the institutional level. Less attention has been paid so far to decisions that take place at the micro level of immediate doctor-patient contact. Current bioethical debates discuss potential tensions between 'Green Healthcare' and an orientation towards ethical principles such as promoting patient welfare or respect for patient autonomy. The article addresses this debate from a different angle starting from the premise that at least some patients might have a preference to reduce carbon outputs that are often deeply rooted in their personal value system. Taking different accounts of patient autonomy as a starting point, the article analyses whether such preferences must be respected as being part of patient autonomy. The analysis comes to a positive conclusion but highlights that certain factors such as misinterpretation, lack of understanding or pressure must be carefully considered. In addition, a patient's climate-related preference does not per se justify the choice of treatment but must be integrated into shared decision-making and reconciled with the healthcare professional's expert judgement on the intervention being a legitimate and promising way for reaching certain treatment goals. As a recommendation, empirical research on stakeholders' attitudes, knowledge and practice regarding ecological sustainability in clinical decision-making is needed together with further ethical analyses.

The Role of Organizational Behavior to Sustainable Health Care: The Case of Greece

The role healthcare systems can play in surmounting global challenges like climatic change and resource scarcity is large, considering the major social and environmental impact. The research investigates the role of organizational behavior in influencing the adoption of sustainability initiatives in Greek healthcare organizations in regard to climate change. The research surveys 379 healthcare professionals from the public and private sectors with regard to organizational attitudes toward climate change, the adoption of sustainable practices, and individual environmental perspectives. Results underline that health care administration is still cut off from environmental considerations, with limited employee involvement in such initiatives of sustainability. The major barriers were poor communication, lack of education, and inadequate awareness across institutions. The study also emphasized that healthcare organizations need to align their values with environmental strategy so they can work in unison toward seeking sustainability. These would be stimulating initiatives for more leadership and active staff who become involved in making meaningful contributions toward global sustainability from the healthcare sector.

Climate change and Vibrio vulnificus dynamics: A blueprint for infectious diseases

Climate change is having increasingly profound effects on human health, notably those associated with the occurrence, distribution, and transmission of infectious diseases. The number of disparate ecological parameters and pathogens affected by climate change are vast and expansive. Disentangling the complex relationship between these variables is critical for the development of effective countermeasures against its effects. The pathogen Vibrio vulnificus, a naturally occurring aquatic bacterium that causes fulminant septicemia, represents a quintessential climate-sensitive organism. In this review, we use V. vulnificus as a model organism to elucidate the intricate network of interactions between climatic factors and pathogens, with the objective of identifying common patterns by which climate change is affecting their disease burden. Recent findings indicate that in regions native to V. vulnificus or related pathogens, climate-driven natural disasters are the chief contributors to their disease outbreaks. Concurrently, climate change is increasing the environmental suitability of areas non-endemic to their diseases, promoting a surge in their natural populations and transmission dynamics, thus elevating the risk of new outbreaks. We highlight potential risk factors and climatic drivers aggravating the threat of V. vulnificus transmission under both scenarios and propose potential measures for mitigating its impact. By defining the mechanisms by which climate change influences V. vulnificus disease burden, we aim to shed light on the transmission dynamics of related disease-causing agents, thereby laying the groundwork for early warning systems and broadly applicable control measures.

The Carbon Footprint of Hospital Services and Care Pathways: A State-of-the-Science Review

BACKGROUND

Climate change is the 21st century's biggest global health threat, endangering health care systems worldwide. Health care systems, and hospital care in particular, are also major contributors to greenhouse gas emissions.

OBJECTIVES

This study used a systematic search and screening process to review the carbon footprint of hospital services and care pathways, exploring key contributing factors and outlining the rationale for chosen services and care pathways in the studies.

METHODS

This state-of-the-science review searched the MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), GreenFILE (EBSCOhost), Web of Science, Scopus, and the HealthcareLCA databases for literature published between 1 January 2000 and 1 January 2024. Gray literature was considered up to 1 January 2024. Inclusion criteria comprised original research reporting on the carbon footprint of hospital services or care pathways. Quality of evidence was assessed according to the guidelines for critical review of product life cycle assessment (LCA). PROSPERO registration number: CRD42023398527.

RESULTS

Of 5,415 records, 76 studies were included, encompassing 151 hospital services and care pathways across multiple medical specialties. Reported carbon footprints varied widely, from 0.01 kg carbon dioxide (CO 2 ) equivalents (kgCO 2 e ) for an hour of intravenously administered anesthesia to 10,200 kgCO 2 e for a year of hemodialysis treatment. Travel, facilities, and consumables were key contributors to carbon footprints, whereas waste disposal had a smaller contribution. Relative importance of carbon hotspots differed per service, pathway, medical specialty, and setting. Studies employed diverse methodologies, including different LCA techniques, functional units, and system boundaries. A quarter of the studies lacked sufficient quality.

DISCUSSION

Hospital services and care pathways have a large climate impact. Quantifying the carbon footprint and identifying hotspots enables targeted and prioritized mitigation efforts. Even for similar services, the carbon footprint varies considerably between settings, underscoring the necessity of localized studies. The emerging field of health care sustainability research faces substantial methodological heterogeneity, compromising the validity and reproducibility of study results. This review informs future carbon footprint studies by highlighting understudied areas in hospital care and providing guidance for selecting specific services and pathways. https://doi.org/10.1289/EHP14754.

Improving sustainability and mitigating the environmental impact of anaesthesia and surgery along the perioperative journey: a narrative review

Climate change, environmental degradation, and biodiversity loss are adversely affecting human health and exacerbating existing inequities, intensifying pressures on already strained health systems. Paradoxically, healthcare is a high-polluting industry, responsible for 4.6% of global greenhouse gas emissions and a similar proportion of air pollutants. Perioperative services are among the most resource-intensive healthcare services and are responsible for some unique pollutants. Opportunities exist to mitigate pollution throughout the entire continuum of perioperative care, including those that occur upstream of the operating room in the process of patient selection and optimisation, delivery of anaesthesia and surgery, and the postoperative recovery period. Within a patient-centred, holistic approach, clinicians can advocate for healthy public policies that modify the determinants of surgical illness, can engage in shared decision-making to ensure appropriate clinical decisions, and can be stewards of healthcare resources. Innovation and collaboration are required to redesign clinical care pathways and processes, optimise logistical systems, and address facility emissions. The results will extend beyond the reduction of public health damages from healthcare pollution to the provision of higher value, higher quality, patient-centred care.

Extreme weather events and disruptions to HIV services: a systematic review

BACKGROUND

Extreme weather events pose a risk to health and disproportionately affect vulnerable groups, such as people living with HIV. We aimed to investigate the effects of extreme weather events on HIV testing uptake, HIV treatment and care, and HIV transmission.

METHODS

For this systematic review, we searched PubMed, Web of Science, and PsycINFO for peer-reviewed studies published between database inception and Aug 31, 2023. Eligible studies were English-language qualitative, quantitative observational (retrospective, prospective, cross-sectional, longitudinal, case-control, and cohort), and mixed-method studies, and randomised controlled trials related to HIV and extreme weather events. We excluded reviews, mathematical models, and case reports. After exporting the search results, two authors independently screened the titles and abstracts of identified articles, reviewing the full text of those that met the inclusion criteria. We used systems thinking to develop a framework linking extreme weather events and HIV and summarised the results using thematic narrative synthesis.

FINDINGS

Of the 6126 studies identified by the search, 27 met the inclusion criteria and were eligible for analysis, of which 19 were quantitative, six were qualitative, and two were mixed-method studies. We identified five main themes linking extreme weather events to HIV: economic and livelihood conditions (12 studies), psychosocial factors (19 studies), infrastructure damage and operational challenges (17 studies), migration and displacement (ten studies), and associated medical conditions and health-care needs (12 studies). We showed how these themes interact in complex ways, resulting in a reduction in uptake of HIV testing, interruption of HIV care and subsequent disease progression, altered risk behaviours, and an increased prevalence of HIV.

INTERPRETATION

Extreme weather events are associated with disruptions to HIV services. Owing to the design of the included studies, we could not establish a causal relationship between extreme weather events and HIV incidence, highlighting a research gap. Appropriate adaptations and mitigation policies that protect the health and wellbeing of people living with HIV during and after extreme weather events are warranted. Such actions will be crucial to achieving the UNAIDS goal of ending HIV as a public health threat by 2030.

FUNDING

None.

Bridging the gender, climate, and health gap: the road to COP29

Focusing specifically on the gender-climate-health nexus, this Personal View builds on existing feminist works and analyses to discuss why intersectional approaches to climate policy and inclusive representation in climate decision making are crucial for achieving just and equitable solutions to address the impacts of climate change on human health and societies. This Personal View highlights how women, girls, and gender-diverse people often face disproportionate climate-related health impacts, particularly those who experience compounding and overlapping vulnerabilities due to current and former systems of oppression. We summarise the insufficient meaningful inclusion of gender, health, and their intersection in international climate governance. Despite the tendency to conflate gender equality with number-based representation, climate governance under the UNFCCC (1995-2023) remains dominated by men, with several countries projected to take over a decade to achieve gender parity in their Party delegations. Advancing gender-responsiveness in climate policy and implementation and promoting equitable participation in climate governance will not only improve the inclusivity and effectiveness of national strategies, but will also build more resilient, equitable, and healthier societies.

Physical Activity as a Victim, a Perpetrator, or Part of the Solution to the Climate Crisis?

Humanity is facing a polycrisis, including climate change, loss of biodiversity, and economic inequalities. This commentary examines the role of physical activity (PA) research in the context of climate change, highlighting 3 perspectives: PA as a victim, as a perpetrator, and as part of the solution. The first perspective conceptualizes PA as a victim of climate change, as heat waves, extreme weather events, and high ozone levels pose a threat to health-enhancing PA and sports; adaptation strategies are needed and potentially lifesaving. The second perspective describes PA as a perpetrator to climate change due to the significant carbon footprint of some forms of PA and sport. The third perspective focuses on PA as a solution to climate change, as some forms of PA-such as active transport and urban gardening-have both individual and planetary health benefits. In addition, PA provides health benefits in extreme situations by reducing stress and maintaining health in times of crisis. Each of these 3 perspectives can guide future research in the field of PA and health.

Single-use synthetic plastic and natural fibre anaesthetic drug trays: a comparative life cycle assessment of environmental impacts

BACKGROUND

Single-use anaesthetic drug trays are used widely in Australia, but their environmental impact is unclear.

METHODS

A life cycle assessment was completed for 10 different types of single-use anaesthetic drug trays made of four materials: the synthetic plastics polypropylene and polystyrene, and the natural fibres bagasse (sugarcane pulp) and cellulose pulp.

RESULTS

Carbon emissions per tray from total life cycle with landfill disposal were 33-454 g CO2-eq, which equates to 152-2066 tonnes CO2-eq annually. Recycling mitigates this impact, reducing emissions per tray to 16-294 g CO2-eq. The tray with the least emissions for landfill and recycling was the small polystyrene injection tray. There was a significant linear relationship between the mass of a tray and its carbon emissions. For landfill, recycling, and incineration disposal, Pearson's r value was 0.98, 0.99, and 0.95, respectively. Composting natural fibres can give a carbon benefit over some synthetic plastics under specific disposal scenarios, but this benefit was not seen under all circumstances. There was a strong positive correlation between the increasing mass of a tray and its increasing environmental impacts for water consumption, particulate matter formation, and mineral depletion.

CONCLUSIONS

Single-use trays with the lowest mass should be preferentially chosen. Recycling and composting will reduce environmental impacts. Natural fibre does not automatically confer any environmental benefit over plastic and sustainability claims should be carefully examined for accuracy. The practice of using a single-use drug tray for every procedure should be reconsidered.

Multilateral funding for health adaptation and the health co-benefits of climate mitigation: An observational study

BACKGROUND

The health impacts of climate change have been increasingly recognised for the past years. However, it remains unclear how this has translated into funding for health adaptation and health co-benefits of climate mitigation.

METHODS

We analysed the projects funded by the Green Climate Fund (GCF) between 2021 and 2023 and the Adaptation Fund between 2019 and 2024 to estimate the amount of funding provided for health adaptation and the health co-benefits of climate mitigation. Based on the Notre Dame Global Adaptation Index (ND-GAIN), we estimated adaptation vulnerability and readiness for each country and investigated the association between this index and the total adaptation funding received by each country.

FINDINGS

Between 2021 and 2023, 85 projects were funded by the GCF, of which 37 were adaptation, 32 cross-cutting, and 16 mitigation projects. The funds provided by the GCF contributed US$764 million to health adaptation (US$178 million in 2021 to US$422 million in 2023). There was no association between the amount of funding provided by the GCF towards adaptation and the estimated vulnerability, resilience, and combined adaptation index (ND-GAIN) at country level. Among the 48 mitigation and cross-cutting projects, 15 did not mention health, 13 mislabelled health co-benefits, 11 identified specific health co-benefits, and 9 correctly identified and measured health co-benefits as outcomes. The main health co-benefits were reduction in the health impact of air pollution, improved nutrition, and reduction in traffic casualties. There were 15 active projects on the Adaptation Fund website, amounting to a total of US$51,944,915. Seven of the projects mentioned health benefits but only one explicitly measured health adaptation indicators as outcomes.

INTERPRETATION

Funding for health adaptation and health co-benefits of mitigation provided by the two main multilateral adaptation funds has been increasing over the recent years. However, it remains insufficient and does not seem to be targeting the countries facing the greatest impacts of climate change.

Impact of extreme temperature on congenital heart disease mortality: a population-based nationwide case-crossover study

Background

The association between congenital heart disease (CHD) and non-optimal temperatures has received limited investigation. We aimed to investigate the impact of extreme temperatures on CHD mortality.

Methods

We reviewed the National Mortality Surveillance System of China and retrieved death records attributable to CHD from 2013 to 2021. Temperature and air pollutants data were obtained from the ERA5-Land reanalysis dataset and the ChinaHighAirPollutants database. A two-stage case-crossover study design was implemented. Sensitivity and subgroup analyses were performed to test the robustness of findings and determine the vulnerable population.

Findings

A total of 32,168 CHD deaths were included, showing a significant association between cold and CHD mortality, while there was little effect for heat. The odd ratio (OR) ranged from 1.05 (95% confidence interval: 1.00-1.10) to 1.15 (1.03-1.29) across country, with a more pronounced impact in non-monsoon regions up to 1.67 (1.20-2.32). Cold extremes accounted for an attributable fraction of 4.09 per 1000 CHD death nationwide and 13.30 per 1000 CHD deaths in non-monsoon regions. Sensitivity analyses utilizing apparent temperature and adjusting for air pollutants confirmed the robustness of the main findings. Female and pediatric CHD patients were identified as the vulnerable population to cold extremes.

Interpretation

For the first time, this nationwide study demonstrated the significant impact of cold extremes on CHD mortality, particularly in non-monsoon regions, and among female and pediatric subgroups. These findings may suggest that healthcare professionals advise CHD patients to avoid exposure to cold extremes, and provide insight into healthcare policy adjustment.

Funding

This study was supported by the CAMS Innovation Fund for Medical Sciences (CIFMS, 2023-I2M-C&T-B-059), the Capital Health Research and Development of Special Fund (2022-1-4032) and the National High Level Hospital Research Funding (2022-GSP-GG-19).