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Lynch M, McCaffery K, Barratt A, Bell K, Miller FA, McGain F, Colagiuri P, Pickles K. Australian and Canadian clinicians' views and application of 'carbon health literacy': a qualitative study. BMC Health Serv Res 2024; 24:1457. [PMID: 39582033 PMCID: PMC11587574 DOI: 10.1186/s12913-024-11903-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 11/08/2024] [Indexed: 11/26/2024] Open
Abstract
BACKGROUND Clinical care contributes to at least 50% of the greenhouse gas (GHG) emissions of healthcare. This includes the 40% of healthcare that is harmful or low value, adding avoidable emissions without improving health or quality of care. Clinicians are well-placed to mitigate emissions associated with the provision of clinical care. This study aimed to explore clinicians' views on a new construct we have termed 'carbon health literacy' to understand how knowledge, skills and capacities related to the emissions of clinical care has application in clinical practice. METHODS Qualitative interviews were conducted between August 2022 and February 2023 with clinicians from Australia (n = 15) and Canada (n = 13). Clinicians with an interest in climate change and healthcare sustainability were sampled from a variety of clinical specialty areas, such as primary care, nursing, anaesthetics, and emergency. Clinicians were recruited through advertising on social media and via professional networks. A pre-piloted interview schedule was used to guide the interviews. Interviews were audio recorded, transcribed verbatim and analysed using framework analysis. RESULTS Participants viewed carbon health literacy as an increasingly important skill for clinicians to have or acquire, though they reported that the level of carbon health literacy and knowledge needed varies by job roles, clinical specialty areas, and individual capacity to generate healthcare system change. Many clinicians reported implementing strategies to mitigate their work-related GHG emissions, such as reducing waste or choosing lower carbon commuting options. There was limited awareness of reducing low-value care as a strategy to decrease emissions. All participants had encountered barriers to providing low-carbon care, including managing patient expectations, inadequate training and information, and limited capacity to generate system change in their organisational roles. CONCLUSIONS To support the delivery of high value low carbon healthcare, work is needed to build the carbon health literacy of clinicians and remove other barriers currently impeding their capacity to practice and promote sustainable clinical care.
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Affiliation(s)
- Michelle Lynch
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Rm 127A Edward Ford Building A27, Camperdown, Sydney, NSW, Australia
| | - Kirsten McCaffery
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Rm 127A Edward Ford Building A27, Camperdown, Sydney, NSW, Australia
- Wiser Healthcare research collaboration, Sydney, Australia
| | - Alexandra Barratt
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Rm 127A Edward Ford Building A27, Camperdown, Sydney, NSW, Australia
- Wiser Healthcare research collaboration, Sydney, Australia
- Health Environments and Lives (HEAL) Global Research Centre, Health Research Institute, Faculty of Health, University of Canberra, ACT, Canberra, Australia
| | - Katy Bell
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Rm 127A Edward Ford Building A27, Camperdown, Sydney, NSW, Australia
- Wiser Healthcare research collaboration, Sydney, Australia
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Collaborative Centre for Climate, Health & Sustainable Care, University of Toronto, Toronto, Canada
| | - Forbes McGain
- Wiser Healthcare research collaboration, Sydney, Australia
- Health Environments and Lives (HEAL) Global Research Centre, Health Research Institute, Faculty of Health, University of Canberra, ACT, Canberra, Australia
- The Healthcare Carbon Lab, Department of Critical Care, University of Melbourne, Parkville, VIC, Australia
- Departments of Anaesthesia and Intensive Care, Western Health, Melbourne, Australia
| | - Philomena Colagiuri
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Rm 127A Edward Ford Building A27, Camperdown, Sydney, NSW, Australia
| | - Kristen Pickles
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Rm 127A Edward Ford Building A27, Camperdown, Sydney, NSW, Australia.
- Wiser Healthcare research collaboration, Sydney, Australia.
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Spanos S, Dammery G, Pagano L, Ellis LA, Fisher G, Smith CL, Foo D, Braithwaite J. Learning health systems on the front lines to strengthen care against future pandemics and climate change: a rapid review. BMC Health Serv Res 2024; 24:829. [PMID: 39039551 PMCID: PMC11265124 DOI: 10.1186/s12913-024-11295-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/09/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND An essential component of future-proofing health systems against future pandemics and climate change is strengthening the front lines of care: principally, emergency departments and primary care settings. To achieve this, these settings can adopt learning health system (LHS) principles, integrating data, evidence, and experience to continuously improve care delivery. This rapid review aimed to understand the ways in which LHS principles have been applied to primary care and emergency departments, the extent to which LHS approaches have been adopted in these key settings, and the factors that affect their adoption. METHODS Three academic databases (Embase, Scopus, and PubMed) were searched for full text articles reporting on LHSs in primary care and/or emergency departments published in the last five years. Articles were included if they had a primary focus on LHSs in primary care settings (general practice, allied health, multidisciplinary primary care, and community-based care) and/or emergency care settings. Data from included articles were catalogued and synthesised according to the modified Institute of Medicine's five-component framework for LHSs (science and informatics, patient-clinician partnerships, incentives, continuous learning culture, and structure and governance). RESULTS Thirty-seven articles were included, 32 of which reported LHSs in primary care settings and seven of which reported LHSs in emergency departments. Science and informatics was the most commonly reported LHS component, followed closely by continuous learning culture and structure and governance. Most articles (n = 30) reported on LHSs that had been adopted, and many of the included articles (n = 17) were descriptive reports of LHS approaches. CONCLUSIONS Developing LHSs at the front lines of care is essential for future-proofing against current and new threats to health system sustainability, such as pandemic- and climate change-induced events. Limited research has examined the application of LHS concepts to emergency care settings. Implementation science should be utilised to better understand the factors influencing adoption of LHS approaches on the front lines of care, so that all five LHS components can be progressed in these settings.
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Affiliation(s)
- Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia.
| | - Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
| | - Lisa Pagano
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
| | - Georgia Fisher
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
| | - Carolynn L Smith
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
| | - Darran Foo
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- Faculty of Medicine, Health and Human Sciences, MQ Health General Practice, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
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Bajpai D, Hailu W, Bagasha P, Chika OU, Hafiz E, Tannor EK, Wijewickrama E, Kalyesubula R, Karam S, Calice-Silva V, Ethier I, Sandal S. Challenges to Implementing Environmentally Sustainable Kidney Care in LMICs: An Opinion Piece. Can J Kidney Health Dis 2024; 11:20543581241246835. [PMID: 38774488 PMCID: PMC11107313 DOI: 10.1177/20543581241246835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Indexed: 05/24/2024] Open
Affiliation(s)
- Divya Bajpai
- Department of Nephrology, King Edward (VII) Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Workagegnehu Hailu
- Unit of Nephrology, Department of Internal Medicine, University of Gondar, Ethiopia
| | - Peace Bagasha
- Directorate of Internal Medicine, Mulago National Specialized Hospital, Kampala, Uganda
| | | | - Ehab Hafiz
- Electron Microscopy Department, Clinical Laboratory Division, Theodor Bilharz Research Institute, Giza, Egypt
| | - Elliot Koranteng Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Eranga Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Robert Kalyesubula
- Department of Physiology, Makerere University and Mulago Hospital, Kampala, Uganda
| | - Sabine Karam
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Minnesota, Minneapolis, USA
- Division of Nephrology and Hypertension, Department of Medicine, American University of Beirut, Lebanon
| | - Viviane Calice-Silva
- Research Department, Pro-rim Foundation and School of Medicine, UNIVILLE, Joinville, Brazil
| | - Isabelle Ethier
- Division of Nephrology, Centre Hospitalier de l’Université de Montréal, Québec, Canada
- Health Innovation and Evaluation hub, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Québec, Canada
| | - Shaifali Sandal
- Divisions of Nephrology and Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
- MEDIC, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Sherratt S. Hearing Loss and Disorders: The Repercussions of Climate Change. Am J Audiol 2023; 32:793-811. [PMID: 37812783 DOI: 10.1044/2023_aja-23-00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
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.
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Affiliation(s)
- Sue Sherratt
- Communication Research Australia, Newcastle, New South Wales
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5
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Smirnova N, Shaver AC, Mehta AJ, Philipsborn R, Scovronick N. Climate Change, Air Quality, and Pulmonary Health Disparities. Clin Chest Med 2023; 44:489-499. [PMID: 37517829 DOI: 10.1016/j.ccm.2023.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Climate change will alter environmental risks that influence pulmonary health, including heat, air pollution, and pollen. These exposures disproportionately burden populations already at risk of ill health, including those at vulnerable life stages, with low socioeconomic status, and systematically targeted by oppressive policies. Climate change can exacerbate existing environmental injustices by affecting future exposure, as well as through differentials in the ability to adapt; this is compounded by disparities in rates of underlying disease and access to health care. Climate change is therefore a dire threat not only to individual and population health but also to health equity.
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Affiliation(s)
- Natalia Smirnova
- Division of Pulmonary, Department of Medicine, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Adam C Shaver
- Division of Pulmonary, Department of Medicine, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Ashish J Mehta
- Division of Pulmonary, Department of Medicine, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA; Atlanta VA Medical Center, Decatur, GA, USA
| | - Rebecca Philipsborn
- Department of Pediatrics, Emory University School of Medicine, 49 Jesse Hill Jr Dr Southeast, Atlanta, GA 30303, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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6
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Govender I. The role of family medicine and primary health care and its impact on the climate crisis. S Afr Fam Pract (2004) 2023; 65:e1-e2. [PMID: 36861908 PMCID: PMC9982468 DOI: 10.4102/safp.v65i1.5658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 02/15/2023] Open
Abstract
No abstract available.
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Affiliation(s)
- Indiran Govender
- Department Family Medicine and Primary Health Care, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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7
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Stress-testing the resilience of the Austrian healthcare system using agent-based simulation. Nat Commun 2022; 13:4259. [PMID: 35871248 PMCID: PMC9308034 DOI: 10.1038/s41467-022-31766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/04/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractPatients do not access physicians at random but rather via naturally emerging networks of patient flows between them. As mass quarantines, absences due to sickness, or other shocks thin out these networks, the system might be pushed to a tipping point where it loses its ability to deliver care. Here, we propose a data-driven framework to quantify regional resilience to such shocks via an agent-based model. For each region and medical specialty we construct patient-sharing networks and stress-test these by removing physicians. This allows us to measure regional resilience indicators describing how many physicians can be removed before patients will not be treated anymore. Our model could therefore enable health authorities to rapidly identify bottlenecks in access to care. Here, we show that regions and medical specialties differ substantially in their resilience and that these systemic differences can be related to indicators for individual physicians by quantifying their risk and benefit to the system.
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8
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Nieder J, Nayna Schwerdtle P, Sauerborn R, Barteit S. Massive Open Online Courses for Health Worker Education in Low- and Middle-Income Countries: A Scoping Review. Front Public Health 2022; 10:891987. [PMID: 35903395 PMCID: PMC9315291 DOI: 10.3389/fpubh.2022.891987] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Massive Open Online Courses (MOOCs) have the potential to improve access to quality education for health care workers (HCWs) globally. Although studies have reported on the use of MOOCs in low- and middle-income countries (LMICs), our understanding of the scope of their utilization or access barriers and facilitators for this cohort is limited. We conducted a scoping review to map published peer-reviewed literature on MOOCs for HCW education in LMICs. We systematically searched four academic databases (Scopus, Web of Science, PubMed, ERIC) and Google Scholar, and undertook a two-stage screening process. The analysis included studies that reported on MOOCs relevant to HCWs' education accessed by HCWs based in LMICs. Results The search identified 1,317 studies with 39 studies included in the analysis, representing 40 MOOCs accessed in over 90 LMICs. We found that MOOCs covered a wide range of HCWs' including nurses, midwives, physicians, dentists, psychologists, and other workers from the broader health care sector, mainly at a post-graduate level. Dominant topics covered by the MOOCs included infectious diseases and epidemic response, treatment and prevention of non-communicable diseases, communication techniques and patient interaction, as well as research practice. Time contribution and internet connection were recognized barriers to MOOC completion, whilst deadlines, email reminders, graphical design of the MOOC, and blended learning modes facilitated uptake and completion. MOOCs were predominantly taught in English (20%), French (12.5%), Spanish (7.5%) and Portuguese (7.5%). Overall, evaluation outcomes were positive and focused on completion rate, learner gain, and student satisfaction. Conclusion We conclude that MOOCs can be an adequate tool to support HCWs' education in LMICs and may be particularly suited for supporting knowledge and understanding. Heterogeneous reporting of MOOC characteristics and lack of cohort-specific reporting limits our ability to evaluate MOOCs at a broader scale; we make suggestions on how standardized reporting may offset this problem. Further research should focus on the impact of learning through MOOCs, as well as on the work of HCWs and the apparent lack of courses covering the key causes of diseases in LMICs. This will result in increased understanding of the extent to which MOOCs can be utilized in this context.
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Affiliation(s)
- Jessica Nieder
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Patricia Nayna Schwerdtle
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Science, Monash University, Clayton, VIC, Australia
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Sandra Barteit
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
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9
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Affiliation(s)
- Naomi Beyeler
- University of California Center for Climate, Health and Equity, San Francisco, CA, USA
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10
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Sullivan JK, Lowe KE, Gordon IO, Colbert CY, Salas RN, Bernstein A, Utech J, Natowicz MR, Mehta N, Isaacson JH. Climate Change and Medical Education: An Integrative Model. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:188-192. [PMID: 34432714 DOI: 10.1097/acm.0000000000004376] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Medical schools face a challenge when trying to include new topics, such as climate change and health (CCH), in their curricula because of competing demands from more traditional biomedical content. At the same time, an understanding of CCH topics is crucial for physicians as they have clear implications for clinical practice and health care delivery. Although some medical schools have begun to incorporate CCH into curricula, the inclusion usually lacks a comprehensive framework for content and implementation. The authors propose a model for integrating CCH into medical school curricula using a practical, multistakeholder approach designed to mitigate competition for time with existing content by weaving meaningful CCH examples into current curricular activities. After the authors identified stakeholders to include in their curricular development working group, this working group determined the goals and desired outcomes of the curriculum; aligned those outcomes with the school's framework of educational objectives, competencies, and milestones; and strove to integrate CCH goals into as many existing curricular settings as possible. This article includes an illustration of the proposed model for one of the curricular goals (understanding the impacts of climate change on communities), with examples from the CCH curriculum integration that began in the fall of 2020 at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. The authors have found that this approach does minimize competition for time with existing content and allows mapping of content to existing curricular competencies and milestones, while encouraging a broad understanding of CCH in the context of individual patients, populations, and communities. This model for curricular integration can be applied to other topics such as social determinants of health, health equity, disability studies, and structural racism.
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Affiliation(s)
- James K Sullivan
- J.K. Sullivan is a third-year medical student, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0001-5853-1590
| | - Katherine E Lowe
- K.E. Lowe is a third-year medical student, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0003-4111-1789
| | - Ilyssa O Gordon
- I.O. Gordon is medical director, Cleveland Clinic Sustainability, and associate professor of pathology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0002-1893-7200
| | - Colleen Y Colbert
- C.Y. Colbert is director, Office of Educator and Scholar Development, Cleveland Clinic, and associate professor of medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0002-2608-7218
| | - Renee N Salas
- R.N. Salas is a Yerby Fellow, Center for Climate, Health, and the Global Environment (C-CHANGE), Harvard T.H. Chan School of Public Health, affiliated faculty, Harvard Global Health Institute, and assistant professor of emergency medicine, Harvard Medical School, Boston, Massachusetts
| | - Aaron Bernstein
- A. Bernstein is director, Center for Climate, Health, and the Global Environment (C-CHANGE), Harvard T.H. Chan School of Public Health, and assistant professor of pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jon Utech
- J. Utech is senior director, Cleveland Clinic Sustainability, Cleveland Clinic, Cleveland, Ohio
| | - Marvin R Natowicz
- M.R. Natowicz is professor of pathology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Neil Mehta
- N. Mehta is professor of medicine and associate dean, Curricular Affairs, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0001-8342-4252
| | - J Harry Isaacson
- J.H. Isaacson is professor of medicine and executive dean, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0002-6791-7898
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Saulnier DD, Thol D, Por I, Hanson C, von Schreeb J, Alvesson HM. 'We have a plan for that': a qualitative study of health system resilience through the perspective of health workers managing antenatal and childbirth services during floods in Cambodia. BMJ Open 2022; 12:e054145. [PMID: 34980624 PMCID: PMC8724583 DOI: 10.1136/bmjopen-2021-054145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Health system resilience can increase a system's ability to deal with shocks like floods. Studying health systems that currently exhibit the capacity for resilience when shocked could enhance our understanding about what generates and influences resilience. This study aimed to generate empirical knowledge on health system resilience by exploring how public antenatal and childbirth health services in Cambodia have absorbed, adapted or transformed in response to seasonal and occasional floods. DESIGN A qualitative study using semi-structured interviews and thematic analysis and informed by the Dimensions of Resilience Governance framework. SETTING Public sector healthcare facilities and health departments in two districts exposed to flooding. PARTICIPANTS Twenty-three public sector health professionals with experience providing or managing antenatal and birth services during recent flooding. RESULTS The theme 'Collaboration across the system creates adaptability in the response' reflects how collaboration and social relationships among providers, staff and the community have delineated boundaries for actions and decisions for services during floods. Floods were perceived as having a modest impact on health services. Knowing the boundaries on decision-making and having preparation and response plans let staff prepare and respond in a flexible yet stable way. The theme was derived from ideas of (1) seasonal floods as a minor strain on the system compared with persistent, system-wide organisational stresses the system already experiences, (2) the ability of the health services to adjust and adapt flood plans, (3) a shared purpose and working process during floods, (4) engagement at the local level to fulfil a professional duty to the community, and (5) creating relationships between health system levels and the community to enable flood response. CONCLUSION The capacity to absorb and adapt to floods was seen among the public sector services. Strategies that enhance stability and flexibility may foster the capacity for health system resilience.
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Affiliation(s)
- Dell D Saulnier
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Dawin Thol
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Ir Por
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Johan von Schreeb
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Thiel C, Schuman JS, Robin AL. Severe Acute Respiratory Syndrome Coronavirus Disease 2019: More Safety at the Expense of More Medical Waste. Ophthalmol Glaucoma 2022; 5:1-4. [PMID: 34090848 PMCID: PMC8172035 DOI: 10.1016/j.ogla.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/20/2022]
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13
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Rasheed FN, Baddley J, Prabhakaran P, De Barros EF, Reddy KS, Vianna NA, Marten R. Decarbonising healthcare in low and middle income countries: potential pathways to net zero emissions. BMJ 2021; 375:n1284. [PMID: 34753746 PMCID: PMC8576604 DOI: 10.1136/bmj.n1284] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | - Poornima Prabhakaran
- Centre for Environmental Health, Public Health Foundation of India, Gurugram, India
| | - Enrique Falceto De Barros
- World Organization of Family Doctors (WONCA), Bruxelles, Belgium
- Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul-Programa de Pós Graduação de Educação em Ciências, Santa Maria do Herval, Brazil
| | | | - Nelzair Araujo Vianna
- Laboratory of Molecular Epidemiology and Biostatistics, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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Bein T, Karagiannidis C, Gründling M, Quintel M. [New challenges for intensive care medicine due to climate change and global warming]. Anaesthesist 2021; 69:463-469. [PMID: 32399720 PMCID: PMC7216862 DOI: 10.1007/s00101-020-00783-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hintergrund In den letzten 5 Dekaden wird ein kontinuierlicher Anstieg der globalen mittleren Temperatur registriert; darüber hinaus häufen sich Naturkatastrophen (z. B. schwere Stürme, Überflutungen, Dürren und großflächige Brände). Die Auswirkungen von globaler Erderwärmung und Klimawandel auf die Gesundheit betreffen die Zunahme von respiratorischen, kardiovaskulären, renalen und kognitiv-psychischen Erkrankungen. Des Weiteren lässt sich auch in Europa eine Veränderung der Häufigkeit und des Musters von Infektionskrankheiten beobachten. Material und Methoden In diesem Beitrag werden die wesentlichen Studien präsentiert, die sich mit klimawandelassoziierten Erkrankungen befassen, mit besonderem Blick auf solche Erkrankungen, die eine Herausforderung für die Intensivmedizin darstellen. Ergebnisse Aktuelle epidemiologische Daten und statistische Extrapolationen legen nahe, dass Erkrankungen im Gefolge des Klimawandels (akute infektionsbedingte respiratorische und intestinale Erkrankungen, Exazerbationen bei vorbestehender Lungenschädigung, hitzebedingte Dehydratation, zerebrale Insulte und Myokardinfarkte) für die Intensivmedizin von Relevanz sind. Ein besonderes Augenmerk liegt auf einer signifikanten Zunahme von akuten Nierenschädigungen während Hitzewellen. Ein bisher nichtgekanntes „Muster“ der Infektionskrankheiten erfordert neue Kenntnisse und gezieltes Management. In einigen Studien wurden nach Hitzewellen und Naturkatastrophen anhaltende psychische Beeinträchtigungen der Betroffenen, z. B. posttraumatische Belastungsstörungen, registriert. Schlussfolgerungen Die Intensivmedizin muss sich den Herausforderungen durch globale Erderwärmung und Klimawandel stellen. Sowohl langsame, aber kontinuierliche (Anstieg der Temperatur) als auch akute Veränderungen (Hitzewellen, Naturkatastrophen) werden den steigenden Bedarf intensivmedizinischer Leistungen (z. B. auch eine steigende Nachfrage nach Nierenersatzverfahren) induzieren. Intensivmediziner werden sich mit der Diagnostik und dem Management von klimawandelassoziierten Erkrankungen beschäftigen müssen. Eine Initiative der betroffenen Fachgesellschaften ist begrüßenswert.
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Affiliation(s)
- T. Bein
- Fakultät für Medizin, Universität Regensburg, 93042 Regensburg, Deutschland
| | - C. Karagiannidis
- Abteilung für Pneumologie und Intensivmedizin, Klinikum Köln-Merheim, ARDS und ECMO Center, Kliniken der Stadt Köln, Witten/Herdecke Universität, 51109 Köln, Deutschland
| | - M. Gründling
- Klinik für Anästhesiologie, Anästhesie, Intensiv‑, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Deutschland
| | - M. Quintel
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Von-Siebold-Str. 3, 37075 Göttingen, Deutschland
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Marten R, Yangchen S, Campbell-Lendrum D, Prats EV, Neira MP, Ghaffar A. Climate change: an urgent priority for health policy and systems research. Health Policy Plan 2021; 36:218-220. [PMID: 33347561 PMCID: PMC7996636 DOI: 10.1093/heapol/czaa165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Sonam Yangchen
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Diarmid Campbell-Lendrum
- Environment, Climate Change and Health Department, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Elena Villalobos Prats
- Environment, Climate Change and Health Department, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Maria Purificacion Neira
- Environment, Climate Change and Health Department, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
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16
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Towards Understanding Interactions between Sustainable Development Goals: The Role of Climate-Well-Being Linkages. Experiences of EU Countries. ENERGIES 2021. [DOI: 10.3390/en14072025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The 2030 Agenda with 17 Sustainable Development Goals (SDGs) is a challenge for all countries in the world. Their implementation may turn out to be a compromise or the creation of effective interactions that dynamize sustainable development. To achieve the SDGs, it is essential to understand how they interact with each other. It seems that in the times of the climate and health crisis caused by the COVID-19 pandemic, caring for the environment and ensuring a healthy life and promoting well-being at all ages is the basis for environmental, economic and social sustainable development. The aim of the study is to compare the degree of implementation of the goals of sustainable development in the scope of goal 13 “Climate action” and goal 3 “Good health and well-being” in the EU countries. In addition, we analyze how trade-offs and synergies between these goals have developed. Data from the Eurostat database were used to achieve the goal. The study used the method of multivariate comparative analysis—linear ordering of objects. The technique for order preference by similarity to an ideal solution (TOPSIS) method was used to measure the studied phenomenon. The results indicate a different degree of implementation of the sustainable development goals related to climate change and the improvement of health and social well-being. Only a few countries have synergy in achieving these goals, most of them compromise, manifesting themselves in improving one goal over another. In the group of analyzed EU countries, a simultaneous deterioration in the effectiveness of achieving both objectives were also noted. Our research also shows that energy policy is an important attribute in improving the achievement of these goals. The conducted analysis fills the gap in the research on the implementation of selected sustainable development goals and their interactions. It contributes to the discussion on increasing the links between them, in particular with regard to emerging compromises. This research can provide a basis for re-prioritizing and intensifying the actions where individual EU countries are lagging most behind.
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Bikomeye JC, Rublee CS, Beyer KMM. Positive Externalities of Climate Change Mitigation and Adaptation for Human Health: A Review and Conceptual Framework for Public Health Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2481. [PMID: 33802347 PMCID: PMC7967605 DOI: 10.3390/ijerph18052481] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022]
Abstract
Anthropogenic climate change is adversely impacting people and contributing to suffering and increased costs from climate-related diseases and injuries. In responding to this urgent and growing public health crisis, mitigation strategies are in place to reduce future greenhouse gas emissions (GHGE) while adaptation strategies exist to reduce and/or alleviate the adverse effects of climate change by increasing systems' resilience to future impacts. While these strategies have numerous positive benefits on climate change itself, they also often have other positive externalities or health co-benefits. This knowledge can be harnessed to promote and improve global public health, particularly for the most vulnerable populations. Previous conceptual models in mitigation and adaptation studies such as the shared socioeconomic pathways (SSPs) considered health in the thinking, but health outcomes were not their primary intention. Additionally, existing guidance documents such as the World Health Organization (WHO) Guidance for Climate Resilient and Environmentally Sustainable Health Care Facilities is designed primarily for public health professionals or healthcare managers in hospital settings with a primary focus on resilience. However, a detailed cross sectoral and multidisciplinary conceptual framework, which links mitigation and adaptation strategies with health outcomes as a primary end point, has not yet been developed to guide research in this area. In this paper, we briefly summarize the burden of climate change on global public health, describe important mitigation and adaptation strategies, and present key health benefits by giving context specific examples from high, middle, and low-income settings. We then provide a conceptual framework to inform future global public health research and preparedness across sectors and disciplines and outline key stakeholders recommendations in promoting climate resilient systems and advancing health equity.
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Affiliation(s)
- Jean C. Bikomeye
- PhD Program in Public and Community Health, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Caitlin S. Rublee
- Department of Emergency Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Kirsten M. M. Beyer
- PhD Program in Public and Community Health, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
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18
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Pongsiri MJ, Bassi AM. A Systems Understanding Underpins Actions at the Climate and Health Nexus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2398. [PMID: 33804531 PMCID: PMC7967726 DOI: 10.3390/ijerph18052398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/05/2021] [Accepted: 02/24/2021] [Indexed: 12/13/2022]
Abstract
Multiple sectors-health and non-health-can determine the health and well-being of people and the condition of the socio-ecological environment on which it depends. At the climate and human health nexus, a systems-based understanding of climate change and health should inform all stages of the policy process from problem conceptualization to design, implementation, and evaluation. Such an understanding should guide countries, their partners, and donors to incorporate health in strategic climate actions based on how health is affected by, and plays a role in, the dynamic interactions across economic, environmental, and societal domains. A systems-based approach to sustainable development has been widely promoted but operationalizing it for project level and policy development and implementation has not been well articulated. Such an approach is especially valuable for informing how to address climate change and health together through policy actions which can achieve multiple, mutually reinforcing goals. This commentary article describes strategic steps including the complementary use of health impact assessment, quantification of health impacts, and linking climate and health actions to national and global policy processes to apply a systems-based approach for developing climate mitigation and adaptation actions with human health benefits.
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Affiliation(s)
| | - Andrea M. Bassi
- KnowlEdge Srl, 21057 Olgiate Olona, Italy;
- School of Public Leadership, Stellenbosch University, Stellenbosch 7602, South Africa
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Affiliation(s)
- Renee N Salas
- Harvard Global Health Institute, Cambridge, MA, USA
- Center for Climate, Health, and the Global Environment, Harvard T H Chan School of Public Health, Boston, MA, USA
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20
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Salas RN, Friend TH, Bernstein A, Jha AK. Adding A Climate Lens To Health Policy In The United States. Health Aff (Millwood) 2020; 39:2063-2070. [PMID: 33284694 DOI: 10.1377/hlthaff.2020.01352] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Climate change increasingly threatens the ability of the US health care system to deliver safe, effective, and efficient care to the American people. The existing health care system has key vulnerabilities that will grow more problematic as the effects of climate change on Americans' lives become stronger. Thus, health care policy makers must integrate a climate lens as they develop health system interventions. Applying a climate lens means assessing climate change-driven health risks and integrating them into policies and other actions to improve the nation's health. This lens can be applied to rethinking how to take a more population-based approach to health care delivery, prioritize health care system decarbonization and resilience, adapt data infrastructure, develop a climate-ready workforce, and pay for care. Our recommendations outline how to include climate-informed assessments into health care decision making and health policy, ultimately leading to a more resilient and equitable health care system that is better able to meet the needs of patients today and in the future.
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Affiliation(s)
- Renee N Salas
- Renee N. Salas is affiliated faculty at the Harvard Global Health Institute, in Cambridge, Massachusetts; Yerby Fellow at the Center for Climate, Health, and the Global Environment (C-CHANGE) at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts; and an assistant professor of emergency medicine at Massachusetts General Hospital and Harvard Medical School, in Boston
| | - Tynan H Friend
- Tynan H. Friend is a research assistant in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health
| | - Aaron Bernstein
- Aaron Bernstein is the assistant faculty lead in the Climate Change and Health Initiative at the Harvard Global Health Institute, interim director of C-CHANGE at the Harvard T. H. Chan School of Public Health, and an assistant professor of pediatrics at Boston Children's Hospital and Harvard Medical School
| | - Ashish K Jha
- Ashish K. Jha is the dean of the Brown University School of Public Health and a general internist at the Providence Veteran Affairs Medical Center, in Providence, Rhode Island
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21
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Kadandale S, Marten R, Dalglish SL, Rajan D, Hipgrave DB. Primary health care and the climate crisis. Bull World Health Organ 2020; 98:818-820. [PMID: 33177781 PMCID: PMC7607470 DOI: 10.2471/blt.20.252882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
- Sowmya Kadandale
- United Nations Children’s Fund, World Trade Centre 2 (22nd Floor), Jalan Jenderal Sudirman Kav. 29-31, Jakarta 12920, Indonesia
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Sarah L Dalglish
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, United States of America (USA)
| | - Dheepa Rajan
- Department for Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
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22
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Yano Y. Blood pressure management in an ecosystem context. Hypertens Res 2020; 43:989-994. [PMID: 32439913 DOI: 10.1038/s41440-020-0464-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 12/21/2022]
Abstract
The Hippocratic text On Airs, Waters, Places advises physicians to attend to all aspects of the environment-the seasons, the wind direction, and the soil and water quality, i.e., the ecosystem-when addressing people's health. Hippocrates emphasizes that the ecosystem influences health, disease, and therapeutic choices. Now is the time to consider how this medical wisdom can be integrated into healthcare systems and utilized for people's health. This review discusses how the ecosystem can affect blood pressure (BP) in humans and provides a synthesis of the related resources available in the literature to inform the actions of healthcare providers.
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Affiliation(s)
- Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA.
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23
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Evaluating Climate between Working Excellence and Organizational Innovation: What Comes First? SUSTAINABILITY 2020. [DOI: 10.3390/su12083340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This research introduces a new concept of organizational climate, seen as a "mediator", namely a factor liable to produce positive effects on both individual performances and on work processes and relations, thereby creating a favorable relationship between work excellence and organizational innovation. Health systems have been called to promote sustainability, as actors who work for the health and well-being of their patients. Starting from these considerations, this work shows the main results of a longitudinal study conducted in the pediatric department of a large hospital in southern Italy, for a period of three years (May 2014–May 2017). The reference survey was very broad because in the first step of the research a general questionnaire was adopted which included various aspects. Subsequently, the analysis of the influence of the “climate” factor was carried out according to a 3-dimensional scheme: structural, interpersonal/relational and individual. The focus was therefore set—especially in the second survey—on those indicators responding to the objective of the research and that were consistent with the epistemological choice made. The main scope was to verify the conditions according to which the organizational climate can emerge as a novel factor capable of siding with and orienting innovative patient-centered policies of human resources management.
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Chamla D, Vivas-Torrealba C. Universal Health Coverage in Fragile and Humanitarian Contexts. Int J Health Policy Manag 2020; 9:89-90. [PMID: 32124595 PMCID: PMC7054647 DOI: 10.15171/ijhpm.2019.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 11/03/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Dick Chamla
- Health Section, Emergency Response Team, UNICEF, Three United Nations Plaza, New York City, NY, USA
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26
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