Petroleum and health care: evaluating and managing health care's vulnerability to petroleum supply shifts

Dengue havoc: overview and eco-friendly strategies to forestall the current epidemic

Dengue fever is a mosquito-borne viral illness that affects over 100 nations around the world, including Africa, America, the Eastern Mediterranean, Southeast Asia, and the Western Pacific. Those who get infected by virus for the second time are at greater risk of having persistent dengue symptoms. Dengue fever has yet to be treated with a long-lasting vaccination or medication. Because of their ease of use, mosquito repellents have become popular as a dengue prevention technique. However, this has resulted in environmental degradation and harm, as well as bioaccumulation and biomagnification of hazardous residues in the ecosystem. Synthetic pesticides have caused a plethora of serious problems that were not foreseen when they were originally introduced. The harm caused by the allopathic medications/synthetic pesticides/chemical mosquito repellents has paved the door to employment of eco-friendly/green approaches in order to reduce dengue cases while protecting the integrity of the nearby environment too. Since the cases of dengue have become rampant these days, hence, starting the medication obtained from green approaches as soon as the disease is detected is advisable. In the present paper, we recommend environmentally friendly dengue management strategies, which, when combined with a reasonable number of vector control approaches, may help to avoid the dengue havoc as well as help in maintaining the integrity of the ecosystem.

Health-care systems' resource footprints and their access and quality in 49 regions between 1995 and 2015: an input-output analysis

BACKGROUND

Strategies to reduce the environmental impact of health care are often limited to greenhouse gas emissions. To broaden their scope, our aim was to determine the evolution of the resource footprints, dependency, and efficiency of health-care systems and to determine the relationship between this evolution and their Healthcare Access and Quality (HAQ) index.

METHODS

We carried out an input-output analysis of 49 health-care systems from 1995 to 2015. We harmonised the EXIOBASE v3.8.2 database-providing data for 49 world regions-to the World Health Organization Health Expenditures Database. We then performed a panel data analysis to understand the relationship between Healthcare Access and Quality index and energy footprint per capita of health-care systems. EXIOBASE3 does not provide measurement errors so it was not possible to propagate the uncertainties as can be done with other input-output databases.

FINDINGS

Health-care systems' footprint increased over the past two decades, reaching 7% of global non-metallic minerals footprint, 4% of global metal ores footprint, and 5% of global fossil fuels footprint in 2013. This increase was mostly due to China, rising from 7% of the non-metallic minerals footprint in 1995 to 45% in 2013. 80% of the health-care systems studied were dependent at more than 50% on fossil fuel imports. The energy footprint per capita was correlated exponentially with the HAQ index but some countries performed much better than others at a given energy footprint. Health-care systems have not become more efficient between 2002 and 2015.

INTERPRETATION

Health-care systems' resources footprint are exponentially linked to their HAQ. Both prevention and efficiency measures will be needed to change this relationship. If it is not enough, high-income countries will have to choose between further reducing the resource consumption of their health-care systems or shifting the efforts to other sectors, health being considered an incompressible need. We call for the creation of a HAQE (health-care access, quality, and efficiency) index that would add resource efficiency to access and quality when ranking health-care systems.

FUNDING

The Shift Project.

Hypothesis: Metformin is a potential reproductive toxicant

Metformin is the first-line oral treatment for type 2 diabetes mellitus and is prescribed to more than 150 million people worldwide. Metformin's effect as a glucose-lowering drug is well documented but the precise mechanism of action is unknown. A recent finding of an association between paternal metformin treatment and increased numbers of genital birth defects in sons and a tendency towards a skewed secondary sex ratio with less male offspring prompted us to focus on other evidence of reproductive side effects of this drug. Metformin in humans is documented to reduce the circulating level of testosterone in both men and women. In experimental animal models, metformin exposure in utero induced sex-specific reproductive changes in adult rat male offspring with reduced fertility manifested as a 30% decrease in litter size and metformin exposure to fish, induced intersex documented in testicular tissue. Metformin is excreted unchanged into urine and feces and is present in wastewater and even in the effluent of wastewater treatment plants from where it spreads to rivers, lakes, and drinking water. It is documented to be present in numerous freshwater samples throughout the world - and even in drinking water. We here present the hypothesis that metformin needs to be considered a potential reproductive toxicant for humans, and probably also for wildlife. There is an urgent need for studies exploring the association between metformin exposure and reproductive outcomes in humans, experimental animals, and aquatic wildlife.

Catalytic C-H aerobic and oxidant-induced oxidation of alkylbenzenes (including toluene derivatives) over VO2+ immobilized on core-shell Fe3O4@SiO2 at room temperature in water

Direct C–H bond oxidation of organic materials, and producing the necessary oxygenated compounds under mild conditions, has attracted increasing interest. The selective oxidation of various alkylbenzenes was carried out by means of a new catalyst containing VO²⁺ species supported on silica-coated Fe₃O₄ nanoparticles using t-butyl hydroperoxide as an oxidant at room temperature in H₂O or solvent-free media. The chemical and structural characterization of the catalyst using several methods such as FTIR spectroscopy, XRD, FETEM, FESEM, SAED, EDX and XPS showed that VO²⁺ is covalently bonded to the silica surface. High selectivity and excellent conversion of various toluene derivatives, with less reactive aliphatic (sp³) C–H bonds, to related benzoic acids were quite noticeable. The aerobic oxygenation reaction of these alkylbenzenes was studied under the same conditions. All the results accompanied by sustainability of the inexpensive and simple magnetically separable heterogeneous catalyst proved the important criteria for commercial applications.

A highly efficient, recoverable, sustainable, economic and eco-friendly catalyst containing VO²⁺ species supported on SiO₂@Fe₃O₄ nanoparticles for selective oxidation of alkylbenzenes using TBHP or O₂ at room temperature in H₂O or solvent-free media.

Sustainable emergency medical service systems: how much energy do we need?

OBJECTIVE

Modern emergency medical service (EMS) systems are vulnerable to both rising energy prices and potential energy shortages. Ensuring the sustainability of EMS systems requires an empirical understanding of the total energy requirements of EMS operations. This study was undertaken to determine the life cycle energy requirements of US EMS systems.

METHODS

Input-output-based energy requirement multipliers for the US economy were applied to the annual budgets for a random sample of 19 metropolitan or county-wide EMS systems. Calculated per capita energy requirements of the EMS systems were used to estimate nationwide EMS energy requirements, and the leading energy sinks of the EMS supply chain were determined.

RESULTS

Total US EMS-related energy requirements are estimated at 30 to 60 petajoules (10(15) J) annually. Direct ("scope 1") energy consumption, primarily in the form of vehicle fuels but also in the form of natural gas and heating oil, accounts for 49% of all EMS-related energy requirements. The energy supply chain-including system electricity consumption ("scope 2") as well as the upstream ("scope 3") energy required to generate and distribute liquid fuels and natural gas-accounts for 18% of EMS energy requirements. Scope 3 energy consumption in the materials supply chain accounts for 33% of EMS energy requirements. Vehicle purchases, leases, maintenance, and repair are the most energy-intense components of the non-energy EMS supply chain (23%), followed by medical supplies and equipment (21%).

CONCLUSION

Although less energy intense than other aspects of the US healthcare system, ground EMS systems require substantial amounts of energy each year.

Localization of health systems in low- and middle-income countries in response to long-term increases in energy prices

External challenges to health systems, such as those caused by global economic, social and environmental changes, have received little attention in recent debates on health systems’ performance in low-and middle-income countries (LMICs). One such challenge in coming years will be increasing prices for petroleum-based products as production from conventional petroleum reserves peaks and demand steadily increases in rapidly-growing LMICs. Health systems are significant consumers of fossil fuels in the form of petroleum-based medical supplies; transportation of goods, personnel and patients; and fuel for lighting, heating, cooling and medical equipment. Long-term increases in petroleum prices in the global market will have potentially devastating effects on health sectors in LMICs who already struggle to deliver services to remote parts of their catchment areas. We propose the concept of “localization,” originating in the environmental sustainability literature, as one element of response to these challenges. Localization assigns people at the local level a greater role in the production of goods and services, thereby decreasing reliance on fossil fuels and other external inputs. Effective localization will require changes to governance structures within the health sector in LMICs, empowering local communities to participate in their own health in ways that have remained elusive since this goal was first put forth in the Alma-Ata Declaration on Primary Health Care in 1978. Experiences with decentralization policies in the decades following Alma-Ata offer lessons on defining roles and responsibilities, building capacity at the local level, and designing appropriate policies to target inequities, all of which can guide health systems to adapt to a changing environmental and energy landscape.

Higher energy prices are associated with diminished resources, performance and safety in Australian ambulance systems

OBJECTIVE

To evaluate the impact of changing energy prices on Australian ambulance systems.

METHODS

Generalised estimating equations were used to analyse contemporaneous and lagged relationships between changes in energy prices and ambulance system performance measures in all Australian State/Territory ambulance systems for the years 2000-2010. Measures included: expenditures per response; labour-to-total expenditure ratio; full-time equivalent employees (FTE) per 10,000 responses; average salary; median and 90th percentile response time; and injury compensation claims. Energy price data included State average diesel price, State average electricity price, and world crude oil price.

RESULTS

Changes in diesel prices were inversely associated with changes in salaries, and positively associated with changes in ambulance response times; changes in oil prices were also inversely associated with changes in salaries, as well with staffing levels and expenditures per ambulance response. Changes in electricity prices were positively associated with changes in expenditures per response and changes in salaries; they were also positively associated with changes in injury compensation claims per 100 FTE.

CONCLUSION

Changes in energy prices are associated with changes in Australian ambulance systems' resource, performance and safety characteristics in ways that could affect both patients and personnel. Further research is needed to explore the mechanisms of, and strategies for mitigating, these impacts. The impacts of energy prices on other aspects of the health system should also be investigated.

The energy burden and environmental impact of health services

OBJECTIVES

We reviewed the English-language literature on the energy burden and environmental impact of health services.

METHODS

We searched all years of the PubMed, CINAHL, and ScienceDirect databases for publications reporting energy consumption, greenhouse gas emissions, or the environmental impact of health-related activities. We extracted and tabulated data to enable cross-comparisons among different activities and services; where possible, we calculated per patient or per event emissions.

RESULTS

We identified 38 relevant publications. Per patient or per event, health-related energy consumption and greenhouse gas emissions are quite modest; in the aggregate, however, they are considerable. In England and the United States, health-related emissions account for 3% and 8% of total national emissions, respectively.

CONCLUSIONS

Although reducing health-related energy consumption and emissions alone will not resolve all of the problems of energy scarcity and climate change, it could make a meaningful contribution.

Public health and medicine in an age of energy scarcity: the case of petroleum

Petroleum supplies have heretofore been abundant and inexpensive, but the world petroleum production peak is imminent, and we are entering an unprecedented era of petroleum scarcity. This fact has had little impact on policies related to climate, energy, the built environment, transportation, food, health care, public health, and global health. Rising prices are likely to spur research and drive efficiency improvements, but such innovations may be unable to address an increasing gap between supply and demand. The resulting implications for health and the environment are explored in the articles we have selected as additional contributions in this special issue. Uncertainty about the timing of the peak, the shape of the production curve, and decline rates should not delay action. The time for quick, decisive, comprehensive action is now.