Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

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.

Implementation of decarbonisation actions in general practice: a systematic review and narrative synthesis protocol

INTRODUCTION

There is growing recognition of the importance of primary care in addressing climate change. The World Organisation of Family Doctors has urged general practitioners worldwide to commit to tackling climate change and to serve as agents of systemic and individual change. Though an increasing number of resources have become available to support the decarbonisation of primary care, there remains a lack of evidence about how primary care teams are using them, their reach across practices, their level of adoption and maintenance, their cost impact and their effect on carbon emissions. This systematic review aims to understand how primary care, with a focus on general practice or equivalent settings within the context of primary care, is implementing decarbonisation actions to reduce carbon emissions arising from its operations, assess efficacy of the actions and generate recommendations on how to assist and accelerate their implementation and effectiveness.

METHODS AND ANALYSIS

The literature search will be conducted on Medline, Embase, Web of Science, CINAHL and ProQuest, from 2007 to 29 March 2024. Article screening will be based on specified inclusion and exclusion criteria. Narrative synthesis will be used to analyse and integrate findings to offer new insights into key mechanisms that support decarbonisation in general practice and help refine an initial programme theory. The reporting of the systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis framework.

ETHICS AND DISSEMINATION

This review did not involve the collection or analysis of any data that was not included in previously published research in the public domain. The results will be disseminated through peer-reviewed publication and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42023470889.

Reassessing 'good' medical practice and the climate crisis

In August 2023, the General Medical Council released the latest update of Good Medical Practice, which sets out the standards of patient care and professional behaviour to be expected of UK doctors. These updated guidelines offer some environmental considerations that previous standards did not include. This paper explores these latest additions to Good Medical Practice through the healthcare ethics lens of non-maleficence, beneficence, justice and autonomy, alongside trust and physician well-being, to make the case that the latest updates to Good Medical Practice do not go far enough in specifying the duties for doctors in responding to climate and ecological emergencies to be seen as ethically justifiable.The paper argues that given the health implications of the climate crisis and the harms associated with high-emission healthcare, as well as the co-benefits of climate action on health, there must be a stronger commitment from the medical regulator to ensure the groundwork is set for doctors to learn, understand and advocate for the importance and urgency of practicing sustainable healthcare. The case for this is strengthened by also examining the importance of maintaining public trust in the medical profession as advocates for public health, along with the notable societal and generational injustices that continue to deepen as the climate emergency escalates.The paper concludes by arguing that doctors can and should be a part of writing a new chapter for health in the climate era, but our standards for practice need to offer a strengthened starting point of consensus for what is expected of the medical profession for that to come to fruition and raise questions as to what doctors can and should do when they have questions over their own regulators' commitment to maintaining public health in relation to the climate and ecological crisis.

The carbon footprint of a Dutch academic hospital-using a hybrid assessment method to identify driving activities and departments

Background

The healthcare sector is responsible for 7% of greenhouse gas (GHG) emissions in the Netherlands. However, this is not well understood on an organizational level. This research aimed to assess the carbon footprint of the Erasmus University Medical Center to identify the driving activities and sources.

Methods

A hybrid approach was used, combining a life cycle impact assessment and expenditure-based method, to quantify the hospital's carbon footprint for 2021, according to scope 1 (direct emissions), 2 (indirect emissions from purchased energy), and 3 (rest of indirect emissions) of the GHG Protocol. Results were disaggregated by categories of purchased goods and services, medicines, specific product groups, and hospital departments.

Results

The hospital emitted 209.5 kilotons of CO2-equivalent, with scope 3 (72.1%) as largest contributor, followed by scope 2 (23.1%) and scope 1 (4.8%). Scope 1 was primarily determined by stationary combustion and scope 2 by purchased electricity. Scope 3 was driven by purchased goods and services, of which medicines accounted for 41.6%. Other important categories were medical products, lab materials, prostheses and implants, and construction investment. Primary contributing departments were Pediatrics, Real Estate, Neurology, Hematology, and Information & Technology.

Conclusion

This is the first hybrid analysis of the environmental impact of an academic hospital across all its activities and departments. It became evident that the footprint is mainly determined by the upstream effects in external supply chains. This research underlines the importance of carbon footprinting on an organizational level, to guide future sustainability strategies.

The untapped health and climate potential of cycling in France: a national assessment from individual travel data

Background

Promoting active modes of transportation such as cycling may generate important public health, economic, and climate mitigation benefits. We aim to assess the mortality and morbidity impacts of cycling in a country with relatively low levels of cycling, France, along with associated monetary benefits. We further assess the potential additional benefits of shifting a portion of short trips from cars to bikes, including projected greenhouse gas emissions savings.

Methods

Using individual data from a nationally representative mobility survey, we described the French 2019 cycling levels by age and sex. We conducted a burden of disease analysis to assess the incidence of five chronic diseases (breast cancer, colon cancer, cardiovascular diseases, dementia, and type-2 diabetes) and the number of deaths prevented by cycling, based on national incidence and mortality data and dose-response relationships from meta-analyses. We assessed the corresponding direct medical cost savings and the intangible costs prevented based on the value of a statistical life year. Lastly, based on individual simulations, we assessed the likely additional benefits of shifting 25% of short (<5 km) car trips to cycling.

Findings

The French adult (20-89 years) population was estimated to cycle on average 1 min 17 sec pers-1 day-1 in 2019, with important heterogeneity across sex and age. This yielded benefits of 1,919 (uncertainty interval, UI: 1,101-2,736) premature deaths and 5,963 (UI: 3,178-8,749) chronic disease cases prevented, with males reaping nearly 75% of these benefits. Direct medical costs prevented were estimated at €191 million (UI: 98-285) annually, while the corresponding intangible costs were nearly 25 times higher (€4.8 billion, UI: 3.0-6.5). We estimated that on average, €1.02 (UI: 0.59-1.62) of intangible costs were prevented for every km cycled. Shifting 25% of short car trips to cycling would yield approximatively a 2-fold increase in deaths prevented, while also generating important CO2 emissions reductions (0.257 MtCO2e, UI: 0.231-0.288).

Interpretation

In a country with a low- to moderate-cycling culture, cycling already generates important public health and health-related economic benefits. Further development of active transportation would increase these benefits while also contributing to climate change mitigation targets.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Health journal coverage of climate change and health: a bibliometric study

OBJECTIVES

To find what proportion of a broad set of health journals have published on climate change and health, how many articles they have published, and when they first published on the subject.

DESIGN

Bibliometric study.

SETTING AND PARTICIPANTS

We conducted electronic searches in Ovid MEDLINE ALL for articles about climate change and human health published from 1860 to 31 December 2022 in 330 health journals. There were no limits by language or publication type. Results were independently screened by two raters for article eligibility.

RESULTS

After screening there were 2932 eligible articles published across 253 of the 330 journals between 1947 and 2022; most (2795/2932; 95%) were published in English. A few journals published articles in the early 90s, but there has been a rapid increase since about 2006. We were unable to categorise the types of publication but estimate that fewer than half are research papers. While articles were published in journals in 39 countries, two-thirds (1929/2932; 66%) were published in a journal published in the UK or the USA. Almost a quarter (77/330; 23%) of the journals published no eligible articles, and almost three-quarters (241/330; 73%) published five articles or fewer. The publication of joint editorials in over 200 journals in 2021 and 2022 boosted the number of journals publishing something on climate change and health. A third of the (112/330; 34%) journals in our sample published at least one of the joint editorials, and almost a third of those (32/112; 29%) were publishing on climate change and health for the first time.

CONCLUSIONS

Health journals are rapidly increasing the amount they publish on climate change and health, but despite climate change being the major threat to global health many journals had until recently published little or nothing. A joint editorial published in multiple journals increased coverage, and for many journals it was the first thing they published on climate change and health.

Investigating the impact of n-heptane (C7H16) and nanoparticles (TiO2) on diesel-microalgae biodiesel blend in CI diesel engines

Recent global challenges encompass profound environmental pollution and the depletion of finite fuel resources. In this study, the biodiesel used in the mixture was derived from Azolla pinnata microalgae oil through a trans-esterification reaction chosen for its high oil concentration. During the initial phase of the experiment, varying volumes of biodiesel (5%, 10%, and 15%) and n-heptane (5%, 10%, and 15%) were introduced to diesel to form a ternary fuel blend. The experimental outcome shows that an n-heptane and biodiesel mixture of 10% by volume would produce the best results. Next, experiments were carried out by incorporating 10, 40, and 80 ppm titanium oxide (TiO2) nanoparticles (NPs) in a recommended ternary fuel blend. The experimental investigation showed that D80A10H10TNP40 (diesel 80% + biodiesel 10% + n-heptane 10% + TiO2 40 ppm) caused a 7.21% increase in brake thermal efficiency (BTE) with a decrease in brake specific fuel consumption (BSFC) and brake specific energy consumption (BSEC) by 9.58% and 10%, respectively, compared to (diesel 80% + biodiesel 20%) D80A20. D80A10H10TNP40 exhibits lower emissions, with a significant reduction of 11.29% and 20.96% in carbon monoxide (CO) and unburnt hydrocarbons (UBHC), respectively. Nitrogen oxide (NOX) and smoke emissions were reduced by 3.3% and 11.13%, respectively, compared to D80A10H10. Furthermore, D80A10H10TNP40 demonstrated enhanced combustion properties, comprising a significant rise of 4.39% in-cylinder pressure (CP), 35.29% in heat release rate (HRR), and 25.05% in the rate of pressure rise (RPR). The findings of this investigation indicate that D80A10H10TNP40 exhibits enhanced efficiency, emission, and combustion properties compared to the D80A20 fuel.

Editorial: Climate Change and the Spread of Vector-Borne Diseases, Including Dengue, Malaria, Lyme Disease, and West Nile Virus Infection

The major health threats from climate change include increasing temperatures, air pollution, extreme weather events, changes in the spread of infectious diseases, antimicrobial resistance, emerging pathogens, and an increase in vector-borne disease. Between October and December 2023, in 200 medical journal, epidemiologists, clinicians, healthcare policymakers, and journal editors published an emergency call to action to health professionals, the United Nations, and political leaders on climate change and its effects on the ecosystem and human health. Also, in December 2023, the Intergovernmental Panel on Climate Change (IPCC) published its sixth Assessment Report (AR6) that summarizes current knowledge, impacts, and health risks from climate change, as well as suggestions for mitigation and adaptation. For over a decade, the IPCC has reported that the prevalence of vector-borne diseases has increased and highlighted the importance of monitoring dengue, malaria, Lyme disease, West Nile virus infection, and other vector-borne diseases. This editorial aims to provide an update on the association between climate change and the spread of vector-borne diseases and highlights the urgent need for public health and disease prevention and treatment strategies to control the rise in vector-borne diseases.

Time to treat the climate and nature crisis as one indivisible global health emergency

doi: https://doi.org/10.12669/pjms.40.1.8841 How to cite this: Zielinski C. Time to treat the climate and nature crisis as one indivisible global health emergency. Pak J Med Sci. 2024;40(1):---------. doi: https://doi.org/10.12669/pjms.40.1.8841 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Towards planetary oral health

It is time to consider the protection of our environment as a major public health issue in oral medicine. Evidence shows that activities related to dental practice, such as patient transportation, use of rare materials and chemicals, or energy consumption, affect our ecosystems and contribute to the global degradation we are increasingly observing. The degradation of our environment is considered the greatest threat to our health. Exposure of oral tissues to multiple environmental factors can lead to pathological conditions. In addition to these direct effects, there are more complex phenomena, leading to co-deficits in the health of populations. The example of the sugar industry illustrates the systemic failures resulting in the double degradation of the environment and the health of individuals. Face with these dynamically interacting phenomena, human communities must consider systemic responses such as those described in this article. The dental community will need to do its part and consider global oral health as a central issue. This conceptual work will help define the innovations and action needed to ensure equitable practice that respects planetary limits.