Health benefits of policies to reduce carbon emissions

The surgical outpatient clinic and the environment

Rising global temperatures will have a radical impact on the environment where global warming is associated with weather extremes such as thunderstorms and droughts which can affect the regional ecosystems. The healthcare sector is a major emitter of greenhouse gasses. Within healthcare, the outpatient clinic is responsible for a considerable sum of emissions. These can be organized under scopes 1, 2 and 3 as described in the Greenhouse Gas Protocol where scope 1 accounts for direct emissions from healthcare facilities, scope 2 is emissions from purchased electricity and scope 3 is indirect emissions including procurement and waste. Emissions and mitigation strategies from the surgical outpatient clinic are outlined under each scope of the Greenhouse Gas Protocol. These include using insulation materials, renovating or building new facilities, incorporating renewable energy sources and utilizing more efficient appliances. Telehealth and virtual clinics have been shown to be an effective method of delivering care while avoiding the combustion of fossil fuels to facilitate patient transport. In addition, virtual set-ups are cost effective and have not been proven to compromise patient safety when implemented correctly.

A scoping review of the health co-benefits of climate mitigation strategies in South America

The accelerated production of greenhouse gases (GHG) due to human activity has led to unprecedented global warming, making climate mitigation strategies crucial for minimizing its impacts. South America, a region highly vulnerable to climate change, stands to benefit from implementing such strategies to reduce future risks and generate health co-benefits. This scoping review, aimed to assess the existing evidence on the health benefits of climate mitigation strategies in South American countries. PubMed, Web of Science, and LILACS databases were searched until June 15, 2023. Nine studies published between 2001 and 2021 were analyzed, focusing on Brazil, Chile, and Bolivia. All the studies identified in this review used scenario modeling. They evaluated various GHG emission mitigation strategies, including land management, reducing livestock production, biofuel production, increased active transportation, renewable energy, and waste reduction. Only one study looked at GHG capture and sequestration through afforestation. Given the limited information available, there is a pressing need for more research on the region's potential health, environmental, and economic co-benefits. This review serves as a starting point and suggests that climate mitigation can offer a range of positive co-benefits, such as improved air quality and increased resilience to climate impacts, thereby advancing public health initiatives.

Funding

MYG was supported by the Wellcome Trust (grant number 209734/Z/17/Z). The other authors did not receive financial support for their research or authorship. The publication of this article was financially supported by Universidad Peruana Cayetano Heredia.

Air Pollution and Diet: Potential Interacting Exposures in Asthma

PURPOSE OF REVIEW

To provide a review of emerging literature describing the impact of diet on the respiratory response to air pollution in asthma.

RECENT FINDINGS

Asthma phenotyping (observable characteristics) and endotyping (mechanistic pathways) have increased the specificity of diagnostic and treatment pathways and opened the doors to the identification of subphenotypes with enhanced susceptibility to exposures and interventions. Mechanisms underlying the airway immune response to air pollution are still being defined but include oxidative stress, inflammation, and activation of adaptive and innate immune responses, with genetic susceptibility highlighted. Of these, neutrophil recruitment and activation appear prominent; however, understanding neutrophil function in response to pollutant exposures is a research gap. Diet may play a role in asthma pathogenesis and morbidity; therefore, diet modification is a potential target opportunity to protect against pollutant-induced lung injury. In particular, in vivo and in vitro data suggest the potential for diet to modify the inflammatory response in the airways, including impacts on neutrophil recruitment and function. Murine models provide compelling results in regard to the potential for dietary components (including fiber, antioxidants, and omega-3 fatty acids) to buffer against the inflammatory response to air pollution in the lung. Precision lifestyle approaches to asthma management and respiratory protection in the context of air pollution exposures may evolve to include diet, pending the results of further epidemiologic and causal investigation and with neutrophil recruitment and activation as a candidate mechanism.

Climate change and human health in the Eastern Mediterranean and Middle East: Literature review, research priorities and policy suggestions

Human health is linked to climatic factors in complex ways, and climate change can have profound direct and indirect impacts on the health status of any given region. Susceptibility to climate change is modulated by biological, ecological and socio-political factors such as age, gender, geographic location, socio-economic status, occupation, health status and housing conditions, among other. In the Eastern Mediterranean and Middle East (EMME), climatic factors known to affect human health include extreme heat, water shortages and air pollution. Furthermore, the epidemiology of vector-borne diseases (VBDs) and the health consequences of population displacement are also influenced by climate change in this region. To inform future policies for adaptation and mitigation measures, and based on an extensive review of the available knowledge, we recommend several research priorities for the region. These include the generation of more empirical evidence on exposure-response functions involving climate change and specific health outcomes, the development of appropriate methodologies to evaluate the physical and psychological effects of climate change on vulnerable populations, determining how climate change alters the ecological determinants of human health, improving our understanding of the effects of long-term exposure to heat stress and air pollution, and evaluating the interactions between adaptation and mitigation strategies. Because national boundaries do not limit most climate-related factors expected to impact human health, we propose that adaptation/mitigation policies must have a regional scope, and therefore require collaborative efforts among EMME nations. Policy suggestions include a decisive region-wide decarbonisation, the integration of environmentally driven morbidity and mortality data throughout the region, advancing the development and widespread use of affordable technologies for the production and management of drinking water by non-traditional means, the development of comprehensive strategies to improve the health status of displaced populations, and fostering regional networks for monitoring and controlling the spread of infectious diseases and disease vectors.

Looking Towards 2030: Strengthening the Environmental Health in Childhood-Adolescent Cancer Survivor Programs

Childhood and adolescent cancer survivors (CACS) are a high-risk population for non-communicable diseases and secondary carcinogenesis. The Environmental and Community Health Program for Longitudinal Follow-up of CACS in the region of Murcia, Spain, is an ongoing pioneering program that constitutes a model for social innovation. This study aims to present the program tools and protocol as a whole, as well as a profile of the incidence, survival, and spatiotemporal distribution of childhood cancer in the region of Murcia, Spain, using 822 sample cases of cancer diagnosed in children under 15 years of age (1998-2020). While the crude incidence rate across that entire period was 149.6 per 1 million, there was an increase over that time in the incidence. The areas with a higher standardized incidence ratio have shifted from the northwest (1998-2003) to the southeast (2016-2020) region. Overall, the ten-year survival rate for all tumor types was 80.1% over the entire period, increasing the five-year survival rate from 76.1 (1998-2003) to 85.5 (2014-2018). CACS living in areas with very poor outdoor air quality had lower survival rates. Furthermore, integrating environmental health into clinical practice could improve knowledge of the etiology and prognosis, as well as the outcomes of CACS. Finally, monitoring individual carbon footprints and creating healthier lifestyles, alongside healthier environments for CACS, could promote wellbeing, environmental awareness, and empowerment in order to attain Sustainable Development Goals for non-communicable diseases in this population.

Poluição do ar

Introdução: As mortes atribuíveis à poluição do ar em longo prazo chegam a 9 milhões ao ano, concentrando-se principalmente em países de baixa e média renda como o Brasil. Classifica-se a poluição do ar em: domiciliar (indoor) ou ambiente (outdoor). A inalação de poluentes está relacionada com o aumento da incidência e desenvolvimento de condições clínicas, como doenças cardiovasculares, respiratórias e outras, que fazem parte da prática da medicina de família e comunidade. Objetivo: Verificar as evidências clínicas para a abordagem da poluição do ar relacionada à saúde humana no contexto da prática na Atenção Primária à Saúde. Métodos: Revisão de escopo do papel clínico da medicina de família e comunidade em relação à poluição do ar e saúde, voltada para questões clínicas associadas com a poluição do ar. Incluíram-se 35 artigos nesta revisão. Recomendações clínicas: Em nível individual, destacam-se a redução do uso de fogões a lenha, o uso de estratégias de proteção de fontes poluidoras (como queimadas, vias de trânsito e indústria), a filtragem do ar, o estímulo ao transporte ativo, a cessação do tabagismo. Essas recomendações devem ser complementares às políticas governamentais relacionadas à poluição do ar. Propõem-se perguntas para a entrevista clínica. Exploram-se recomendações específicas sobre uso de máscaras, atividade física e COVID-19. Sugerem-se temas de pesquisa que podem ser realizadas na Atenção Primária à Saúde e o papel da medicina de família e comunidade nesse contexto. Considerações: A inclusão na classificação internacional de atenção primária e no Código internacional de Doenças poderia melhorar a notificação e os estudos epidemiológicos sobre o assunto.

Nurse-sensitive environmental indicators: A qualitative study

AIM

This study aims to explore the proposed concept of "nurse-sensitive environmental indicators" among nursing and non-nursing leaders of environmental stewardship who work with nurses.

BACKGROUND

Aligned with the Sustainable Development Goals, nurses are obligated to "practice in a manner that advances environmental safety and health." Little is known about environmental impacts in acute-care nursing.

METHODS

Nursing and non-nursing leaders of environmental stewardship across the United States (N = 9) were interviewed to explore the concept of acute-care nurse-sensitive environmental indicators. Transcripts were examined using qualitative descriptive analysis.

RESULTS

Thematic analysis revealed that nurses are in key positions to influence environmental change, need more education and awareness to be effective, and need leadership support and role-modelling. Issues related to waste were highly nurse sensitive; issues related to food, chemicals, and transportation were moderately nurse sensitive; issues related to energy and water were minimally nurse sensitive.

CONCLUSION

Preliminary consensus on nurse-sensitive environmental indicators was confirmed by leader participants in this study.

IMPLICATIONS FOR NURSING MANAGEMENT

To help meet environmentally focused Sustainable Development Goals, nursing leaders can use the concept of nurse-sensitive environmental indicators in planning, education, resource allocation, and leadership to improve environmental stewardship in acute care nursing.

A Transparency Checklist for Carbon Footprint Calculations Applied within a Systematic Review of Virtual Care Interventions

Increasing concerns about climate change imply that decisions on the digitization of healthcare should consider evidence about its carbon footprint (CF). This study aims to develop a transparency catalogue for reporting CF calculations, to compare results, and to assess the transparency (reporting quality) of the current evidence of virtual care (VC) intervention. We developed a checklist of transparency criteria based on the consolidation of three established standards/norms for CF calculation. We conducted a systematic review of primary studies written in English or German on the CF of VC interventions to check applicability. Based on our checklist, we extracted methodological information. We compared the results and calculated a transparency score. The checklist comprises 22 items in the aim, scope, data and analysis categories. Twenty-three studies out of 1466 records were included, mostly addressing telemedicine. The mean transparency score was 38% (minimum 14%, maximum 68%). On average, 148 kg carbon dioxide equivalents per patient were saved. Digitization may have co-benefits, improving care and reducing the healthcare CF. However, the evidence for this is weak, and CF reports are heterogeneous. Our transparency checklist may serve as a reference for developing a standard to assess the CF of virtual and other healthcare and public health services.

A protocol for analysing the effects on health and greenhouse gas emissions of implemented climate change mitigation actions

Background: It is crucial to understand the benefits to human health from decarbonisation to galvanise action among decision makers. Most of our existing evidence comes from modelling studies and little is known about the extent to which the health co-benefits of climate change mitigation actions are realised upon implementation. We aim to analyse evidence from mitigation actions that have been implemented across a range of sectors and scales, to identify those that can improve and sustain health, while accelerating progress towards a zero-carbon economy.

Objectives: To understand the implementation process of actions and the role of key actors; explain the contextual elements influencing these actions; summarise what effects, both positive and negative, planned and unplanned they may have on emissions of greenhouse gases and health; and to summarise environmental, social, or economic co-benefits.

Data: We will review evidence collected through partnership with existing data holders and an open call for evidence. We will also conduct a hand search of reference lists from systematic reviews and websites of organisations relevant to climate change mitigation.

Screening: Screening will be done by two reviewers according to a pre-defined inclusion and exclusion criteria.

Analysis: We will identify gaps where implementation or evaluation of implementation of mitigation actions is lacking. We will synthesise the findings to describe how actions were implemented and how they achieved results in different contexts, identifying potential barriers and facilitators to their design, implementation, and uptake. We will also synthesise their effect on health outcomes and other co-benefits. Quantitative synthesis will depend on the heterogeneity of outcomes and metrics.

Conclusions: Findings will be used to identify lessons that can be learned from successful and unsuccessful mitigation actions, to make inferences on replicability, scalability, and transferability and will contribute to the development of frameworks that can be used by policy makers.

A protocol for analysing the effects on health and greenhouse gas emissions of implemented climate change mitigation actions

Background: It is crucial to understand the benefits to human health from decarbonisation to galvanise action among decision makers. Most of our existing evidence comes from modelling studies and little is known about the extent to which the health co-benefits of climate change mitigation actions are realised upon implementation. We aim to analyse evidence from mitigation actions that have been implemented across a range of sectors and scales, to identify those that can improve and sustain health, while accelerating progress towards a zero-carbon economy. Objectives: To understand the implementation process of actions and the role of key actors; explain the contextual elements influencing these actions; summarise what effects, both positive and negative, planned and unplanned they may have on emissions of greenhouse gases and health; and to summarise environmental, social, or economic co-benefits. Data: We will review evidence collected through partnership with existing data holders and an open call for evidence. We will also conduct a hand search of reference lists from systematic reviews and websites of organisations relevant to climate change mitigation. Screening: Screening will be done by two reviewers according to a pre-defined inclusion and exclusion criteria. Analysis: We will identify gaps where implementation or evaluation of implementation of mitigation actions is lacking. We will synthesise the findings to describe how actions were implemented and how they achieved results in different contexts, identifying potential barriers and facilitators to their design, implementation, and uptake. We will also synthesise their effect on health outcomes and other co-benefits. Quantitative synthesis will depend on the heterogeneity of outcomes and metrics. Conclusions: Findings will be used to identify lessons that can be learned from successful and unsuccessful mitigation actions, to make inferences on replicability, scalability, and transferability and will contribute to the development of frameworks that can be used by policy makers.

Action plan for the mitigation of greenhouse gas emissions in the hospital-based health care of the Hellenic Army

Climate change is a growing threat for human health and well-being, one that will seriously impact and potentially disrupt all economic sectors and supply chains, such as trade, tourism, agriculture, forestry, and fisheries. The environmental impact of the delivery of medical and hospital care, which generates its own greenhouse gas emissions, needs to be examined and analyzed in detail in order to design and implement effective mitigation actions and measures. Hospital internal energy use processes include the energy consumed for hospital operation, such as lighting, heating, cooking, waste treatment, and other functions associated with the logistical and operational support of hospitals. The present research work, which follows the assessment undertaken in a previous study of the transport activities of the 401 Military General Hospital of Athens (401 MGHA), focuses on the carbon footprint of the stationary emission sources of the 401 MGHA; it serves as a second step in the development of an action plan for the mitigation of greenhouse gas emissions in the hospital-based health care of the Hellenic (Greek) Army. A portfolio of energy saving and emission reduction actions is proposed and mapped according to their abatement cost and greenhouse gas (GHG) reduction potential. The highest decrease of GHG emissions is expected to be materialized by the decarbonization of the Greek power sector due to the lignite phase-out and increased share of low carbon fuels and renewable energy sources. Significant emission reduction potential could also be achieved by the replacement of face-to-face hospital visits by telemedicine, primarily by reducing transport-associated emissions. Furthermore, a number of key performance indicators (KPI) are proposed as simple and easily monitored metrics of the hospital's performance towards its sustainable low carbon objectives. Specific KPIs per mitigation action are presented, as well as a general KPI that covers all mitigation actions and sources of emissions in the form of "tCO₂eq per patient" or "tCO₂eq per hospitalization day."

Evidence-informed policy for tackling adverse climate change effects on health: Linking regional and global assessments of science to catalyse action

Robin Fears and co-authors discuss evidence-informed regional and global policy responses to health impacts of climate change.

The public health implications of the Paris Agreement: a modelling study

BACKGROUND

nationally determined contributions (NDCs) serve to meet the goals of the Paris Agreement of staying "well below 2°C", which could also yield substantial health co-benefits in the process. However, existing NDC commitments are inadequate to achieve this goal. Placing health as a key focus of the NDCs could present an opportunity to increase ambition and realise health co-benefits. We modelled scenarios to analyse the health co-benefits of NDCs for the year 2040 for nine representative countries (ie, Brazil, China, Germany, India, Indonesia, Nigeria, South Africa, the UK, and the USA) that were selected for their contribution to global greenhouse gas emissions and their global or regional influence.

METHODS

Modelling the energy, food and agriculture, and transport sectors, and mortality related to risk factors of air pollution, diet, and physical activity, we analysed the health co-benefits of existing NDCs and related policies (ie, the current pathways scenario) for 2040 in nine countries around the world. We compared these health co-benefits with two alternative scenarios, one consistent with the goal of the Paris Agreement and the Sustainable Development Goals (ie, the sustainable pathways scenario), and one in line with the sustainable pathways scenario, but also placing health as a central focus of the policies (ie, the health in all climate policies scenario).

FINDINGS

Compared with the current pathways scenario, the sustainable pathways scenario resulted in an annual reduction of 1·18 million air pollution-related deaths, 5·86 million diet-related deaths, and 1·15 million deaths due to physical inactivity, across the nine countries, by 2040. Adopting the more ambitious health in all climate policies scenario would result in a further reduction of 462 000 annual deaths attributable to air pollution, 572 000 annual deaths attributable to diet, and 943 000 annual deaths attributable to physical inactivity. These benefits were attributable to the mitigation of direct greenhouse gas emissions and the commensurate actions that reduce exposure to harmful pollutants, as well as improved diets and safe physical activity.

INTERPRETATION

A greater consideration of health in the NDCs and climate change mitigation policies has the potential to yield considerable health benefits as well as achieve the "well below 2°C" commitment across a range of regional and economic contexts.

FUNDING

This work was in part funded through an unrestricted grant from the Wellcome Trust (award number 209734/Z/17/Z) and supported by an Engineering and Physical Sciences Research Council grant (grant number EP/R035288/1).

Health care's response to climate change: a carbon footprint assessment of the NHS in England

BACKGROUND

Climate change threatens to undermine the past 50 years of gains in public health. In response, the National Health Service (NHS) in England has been working since 2008 to quantify and reduce its carbon footprint. This Article presents the latest update to its greenhouse gas accounting, identifying interventions for mitigation efforts and describing an approach applicable to other health systems across the world.

METHODS

A hybrid model was used to quantify emissions within Scopes 1, 2, and 3 of the Greenhouse Gas Protocol, as well as patient and visitor travel emissions, from 1990 to 2019. This approach complements the broad coverage of top-down economic modelling with the high accuracy of bottom-up data wherever available. Available data were backcasted or forecasted to cover all years. To enable the identification of measures to reduce carbon emissions, results were disaggregated by organisation type.

FINDINGS

In 2019, the health service's emissions totalled 25 megatonnes of carbon dioxide equivalent, a reduction of 26% since 1990, and a decrease of 64% in the emissions per inpatient finished admission episode. Of the 2019 footprint, 62% came from the supply chain, 24% from the direct delivery of care, 10% from staff commute and patient and visitor travel, and 4% from private health and care services commissioned by the NHS.

INTERPRETATION

This work represents the longest and most comprehensive accounting of national health-care emissions globally, and underscores the importance of incorporating bottom-up data to improve the accuracy of top-down modelling and enabling detailed monitoring of progress as health systems act to reduce emissions.

FUNDING

Wellcome Trust.