COVID-19, climate change, and communities

Community-level exposomics: a population-centered approach to address public health concerns

Environmental factors affecting health and vulnerability far outweigh genetics in accounting for disparities in health status and longevity in US communities. The concept of the exposome, the totality of exposure from conception onwards, provides a paradigm for researchers to investigate the complex role of the environment on the health of individuals. We propose a complementary framework, community-level exposomics, for population-level exposome assessment. The goal is to bring the exposome paradigm to research and practice on the health of populations, defined by various axes including geographic, social, and occupational. This framework includes the integration of community-level measures of the built, natural and social environments, environmental pollution-derived from conventional and community science approaches, internal markers of exposure that can be measured at the population-level and early responses associated with health status that can be tracked using population-based monitoring. Primary challenges to the implementation of the proposed framework include needed advancements in population-level measurement, lack of existing models with the capability to produce interpretable and actionable evidence and the ethical considerations of labeling geographically-bound populations by exposomic profiles. To address these challenges, we propose a set of recommendations that begin with greater engagement with and empowerment of affected communities and targeted investment in community-based solutions. Applications to urban settings and disaster epidemiology are discussed as examples for implementation.

Transforming global health education during the COVID-19 era: perspectives from a transnational collective of global health students and recent graduates

Inspired by the 2021 BMJ Global Health Editorial by Atkins et al on global health (GH) teaching during the COVID-19 pandemic, a group of GH students and recent graduates from around the world convened to discuss our experiences in GH education during multiple global crises. Through weekly meetings over the course of several months, we reflected on the impact the COVID-19 pandemic and broader systemic inequities and injustices in GH education and practice have had on us over the past 2 years. Despite our geographical and disciplinary diversity, our collective experience suggests that while the pandemic provided an opportunity for changing GH education, that opportunity was not seized by most of our institutions. In light of the mounting health crises that loom over our generation, emerging GH professionals have a unique role in critiquing, deconstructing and reconstructing GH education to better address the needs of our time. By using our experiences learning GH during the pandemic as an entry point, and by using this collective as an incubator for dialogue and re-imagination, we offer our insights outlining successes and barriers we have faced with GH and its education and training. Furthermore, we identify autonomous collectives as a potential viable alternative to encourage pluriversality of knowledge and action systems and to move beyond Western universalism that frames most of traditional academia.

Environmental health, COVID-19, and the syndemic: internal medicine facing the challenge

Internists are experts in complexity, and the COVID-19 pandemic is disclosing complex and unexpected interactions between communicable and non-communicable diseases, environmental factors, and socio-economic disparities. The medicine of complexity cannot be limited to facing comorbidities and to the clinical management of multifaceted diseases. Evidence indicates how climate change, pollution, demographic unbalance, and inequalities can affect the spreading and outcomes of COVID-19 in vulnerable communities. These elements cannot be neglected, and a wide view of public health aspects by a "one-health" approach is strongly and urgently recommended. According to World Health Organization, 35% of infectious diseases involving the lower respiratory tract depend on environmental factors, and infections from SARS-Cov-2 is not an exception. Furthermore, environmental pollution generates a large burden of non-communicable diseases and disabilities, increasing the individual vulnerability to COVID-19 and the chance for the resilience of large communities worldwide. In this field, the awareness of internists must increase, as privileged healthcare providers. They need to gain a comprehensive knowledge of elements characterizing COVID-19 as part of a syndemic. This is the case when pandemic events hit vulnerable populations suffering from the increasing burden of chronic diseases, disabilities, and social and economic inequalities. Mastering the interplay of such events requires a change in overall strategy, to adequately manage not only the SARS-CoV-2 infection but also the growing burden of non-communicable diseases by a "one health" approach. In this context, experts in internal medicine have the knowledge and skills to drive this change.

Climate change and COVID-19: Interdisciplinary perspectives from two global crises

The repercussions of the COVID-19 pandemic and climate change - two major current global crises - are far-reaching, the parallels between the two are striking, and their influence on one another are significant. Based on the wealth of evidence that has emerged from the scientific literature during the first two years of the pandemic, this study argues that these two global crises require holistic multisectoral mitigation strategies. Despite being different in nature, neither crisis can be effectively mitigated without considering their interdependencies. Herein, significant interactions between these two crises are highlighted and discussed. Major implications related to the economy, energy, technology, environment, food systems and agriculture sector, health systems, policy, management, and communities are detailed via a review of existing joint literature. Based on these outcomes, practical recommendations for future research and management are provided. While the joint timing of these crises has created a global conundrum, the COVID-19 pandemic has demonstrated opportunities and lessons for devising sustainable recovery plans in relation to the climate crisis. The findings indicated that governments should work collaboratively to develop durable and adjustable strategies in line with long-term, global decarbonisation targets, promote renewable energy resources, integrate climate change into environmental policies, prioritise climate-smart agriculture and local food systems, and ensure public and ecosystem health. Further, differences in geographic distributions of climate change and COVID-19 related death cases revealed that these crises pose different threats to different parts of the world. These learnings provide insights to address the climate emergency - and potential future global problems with similar characteristics - if international countries act urgently and collectively.