Positive Externalities of Climate Change Mitigation and Adaptation for Human Health: A Review and Conceptual Framework for Public Health Research

Health systems response to climate change adaptation: a scoping review of global evidence

BACKGROUND

The health system plays a critical role in safeguarding the well-being of communities in the face of health risks associated with climate change. This review maps evidence on health systems' adaptation to climate risk and barriers to effective adaptation.

METHODS

This review followed the recommendations by Arksey and O'Malley for conducting scoping review. Search for records was conducted in PubMed, Central, Web of Science, JSTOR, Google, and Google Scholar. Only peer-reviewed papers published in English language were included in this review. All the 63 included studies were critically appraise d.

RESULTS

We found that efforts are being made to create resilient health systems by incorporating climate change into health policies. Investments are being made in innovative technologies, climate-resilient health infrastructure, enhancing healthcare delivery, developing the capacity of climate specialists and agencies to provide high-quality evidence for resilient health systems. We also found that several obstacles prevent health system adaptation to climate risk, including poor policy implementation and evaluation. The obstacles are further exacerbated by financial constraints, including poverty, a lack of political commitment, inadequate data, and deficient healthcare systems, especially in developing countries. There is also a lack of integration of climate change into mental health actions and the health and safety of healthcare workers.

CONCLUSION

Efforts to develop resilient health systems against climate risks are underway, but persistent obstacles, including inadequate policy implementation, resource limitations, and a lack of integration of climate change into critical health domains, hinder comprehensive adaptation measures, particularly in developing nations.

Climate change and its impact on asthma

ABSTRACT

Earth's climate is changing at an unprecedented pace, primarily due to anthropogenic causes including greenhouse gas emissions. Evidence shows a strong link between climate change and its effects on asthma. Healthcare professionals must be educated to advocate for and lead effective strategies to reduce the health risks of climate change.

Disparities in Cardiovascular Disease-Related Outcomes Among Cancer Survivors in the United States: A Systematic Review of the Literature

BACKGROUND

Cancer and cardiovascular disease (CVD) are major causes of morbidity and mortality in the United States (US). Cancer survivors have increased risks for CVD and CVD-related mortality due to multiple factors including cancer treatment-related cardiotoxicity. Disparities are rooted in differential exposure to risk factors and social determinants of health (SDOH), including systemic racism. This review aimed to assess SDOH's role in disparities, document CVD-related disparities among US cancer survivors, and identify literature gaps for future research.

METHODS

Following the Peer Review of Electronic Search Strategies (PRESS) guidelines, MEDLINE, PsycINFO, and Scopus were searched on March 15, 2021, with an update conducted on September 26, 2023. Articles screening was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, a pre-defined Population, Exposure, Comparison, Outcomes, and Settings (PECOS) framework, and the Rayyan platform. A modified version of the Newcastle-Ottawa Scale was used to assess the risk of bias, and RAW Graphs for alluvial charts. This review is registered with PROSPERO under ID #CRD42021236460.

RESULTS

Out of 7,719 retrieved articles, 24 were included, and discussed diverse SDOH that contribute to CVD-related disparities among cancer survivors. The 24 included studies had a large combined total sample size (n=7,704,645; median=19,707). While various disparities have been investigated, including rural-urban, sex, socioeconomic status, and age, a notable observation is that non-Hispanic Black cancer survivors experience disproportionately adverse CVD outcomes when compared to non-Hispanic White survivors. This underscores historical racism and discrimination against non-Hispanic Black individuals as fundamental drivers of CVD-related disparities.

CONCLUSIONS

Stakeholders should work to eliminate the root causes of disparities. Clinicians should increase screening for risk factors that exacerbate CVD-related disparities among cancer survivors. Researchers should prioritise the investigation of systemic factors driving disparities in cancer and CVD and develop innovative interventions to mitigate risk in cancer survivors.

Identifying mitigation strategies of comprehensive health centers against dust hazard: a qualitative study in Iran

BACKGROUND

Exposure to dust can disrupt healthcare services and severely affect all activity domains of the health system. The aim of this study was to explore mitigation strategies for comprehensive health centers against dust hazard.

METHOD

The present study was conducted using a qualitative design with a conventional content analysis approach in 2023. The participants in this study were managers and staff of comprehensive health centers and experts in health in disasters and emergencies in Kerman, Bam, Regan, and Ahvaz. Data were collected through interviews. Data collection continued until data saturation. The collected data were analyzed based on the steps proposed by Graneheim and Lundman. Participants' statements, after recording and transcribing, were categorized into semantic units. Data were analyzed by using MAXQDA software version 2020.

RESULTS

The analysis of the data with 23 participants revealed 106 Codes, 13 sub- categories and 5 main categories including: (A) reducing the impact of dust hazards, (B) management functions, (C) empowerment and performance improvement, (D) maintaining and promoting safety, and (E) Inter-sectoral coordination to implement mitigation strategies.

CONCLUSION

The findings showed that the mitigation strategies and solutions can be used by health policymakers and planners to reduce the impact of dust hazard, empower and motivate healthcare staff, develop training protocols to enhance risk perception of the staff and members of the community, create the necessary infrastructure for adoption of effective mitigation strategies in healthcare centers to create resilience and continue service delivery.

Climate change perception and its association with cancer screening intent

As the climate crisis deepens, its adverse effects on human health are becoming evident, including impacts on cancer pathogenesis and treatment. This study explored the link between individuals' awareness of the health impacts of climate change and interest in cancer screening. Using the 2021 Health Information National Trends Survey, our study demonstrated a statistically significant association between recognition of climate change as a personal health threat and interest in cancer screening. Although the study's retrospective nature and self-reported data pose some limitations, these findings signal a promising avenue for future research on the intersection of climate and cancer risk. This research supports the development of public health interventions that incorporate components of environmental health literacy alongside cancer screening efforts.

Building climate resilience: awareness of climate change adaptation in German outpatient medical practices

BACKGROUND

Climate change is seen as the biggest health threat of the twenty-first century. Making outpatient medical practices resilient is therefore crucial to protect vulnerable groups and maintain quality of care. Awareness is a precondition for action. This study aims to explore awareness (knowledge, experience and attention) of climate change adaptation among stakeholders of outpatient medical practices.

METHODS

Semi-structured interviews and focus groups with stakeholders of outpatient medical practices were conducted. The qualitative data were analysed in a two-step Thematic Analysis process.

RESULTS

In total, n = 40 stakeholders participated in two focus groups and 26 interviews. The findings show a mixed degree of awareness in outpatient medical practices. The spectrum ranged from a passive role with curative acting only, handing over responsibility to others and a low perceived self-efficacy to a proactive and responsible implementation of adaptation strategies. Participants who saw the need and responsibility of climate change adaptation in medical practices perceived low additional workload. In general, implementation of climate change adaptation measures and general awareness of climate change adaptation appeared to be depending on a certain tension for change and a higher self-efficacy.

CONCLUSION

Medical practices, and specifically primary care, plays a crucial role in climate change adaptation, and awareness needs to be increased further in order to cope with consequences of climate change. To facilitate this, there should be a strong emphasis on climate change adaptation strategies being part of outpatient care provider roles rather than being perceived as an "add-on" to already high workloads.

A Scoping Review of Urban Planning Decision Support Tools and Processes That Account for the Health, Environment, and Economic Benefits of Trees and Greenspace

Compelling evidence shows that trees and greenspaces positively impact human well-being and the environment and offer economic benefits. Nevertheless, there exists a knowledge gap regarding the extent to which this evidence is efficiently incorporated into existing urban planning decision-making processes. This scoping review identified the extent to which urban planning decision-making frameworks, models, and tools consider the health, environmental, and economic benefits of trees and greenspace. Out of 28 reviewed studies, 11 (39%) reported on frameworks, models, and tools that take into account the health, environmental, and economic dimensions of trees and greenspace. Additionally, seven studies provided comprehensive coverage of at least one of the three key dimensions. However, none of the decision support frameworks, models, or tools comprehensively integrated all three dimensions, with only two tools (7%) scoring above 50% (five or more out of nine) in terms of comprehensiveness. This review highlights the urgent need to incorporate the true economic and monetary values of the health and environmental benefits of trees and greenspace to inform urban development decision making.

Effects on child and adolescent health of climate change mitigation policies: A systematic review of modelling studies

There is a growing body of modelling evidence that demonstrates the potential for immediate and substantial benefits to adult health from greenhouse gas mitigation actions, but the effects on the health of younger age groups is largely unknown. We conducted a systematic review to identify the available published evidence of the modelled effects on child and adolescent health (≤18 years of age) of greenhouse gas mitigation. We searched six databases of peer-reviewed studies published between January 1, 1990 and July 27, 2022, screened 27,282 original papers and included 23 eligible papers. All included studies were set in high- and middle-income countries; and all studies modelled the effects of interventions that could mitigate greenhouse gas emissions and improve air quality. Most of the available evidence suggests positive benefits for child and adolescent respiratory health from greenhouse gas mitigation actions that simultaneously reduce air pollution (specifically PM2.5 and nitrogen dioxide). We found scant evidence on child and adolescent health from regions more vulnerable to climate change, or on mitigation interventions that could affect exposures other than air pollution.

Historical redlining and breast cancer treatment and survival among older women in the United States

BACKGROUND

Breast cancer (BC) is the most common cancer among US women, and institutional racism is a critical cause of health disparities. We investigated impacts of historical redlining on BC treatment receipt and survival in the United States.

METHODS

Home Owners' Loan Corporation (HOLC) boundaries were used to measure historical redlining. Eligible women in the 2010-2017 Surveillance, Epidemiology, and End Results-Medicare BC cohort were assigned a HOLC grade. The independent variable was a dichotomized HOLC grade: A and B (nonredlined) and C and D (redlined). Outcomes of receipt of various cancer treatments, all-cause mortality (ACM), and BC-specific mortality (BCSM) were analyzed using logistic or Cox models. Indirect effects by comorbidity were examined.

RESULTS

Among 18 119 women, 65.7% resided in historically redlined areas (HRAs), and 32.6% were deceased at a median follow-up of 58 months. A larger proportion of deceased women resided in HRAs (34.5% vs 30.0%). Of all deceased women, 41.6% died of BC; a larger proportion resided in HRAs (43.4% vs 37.8%). Historical redlining is a statistically significant predictor of poorer survival after BC diagnosis (hazard ratio = 1.09, 95% confidence interval [CI] = 1.03 to 1.15 for ACM, and hazard ratio = 1.26, 95% CI = 1.13 to 1.41 for BCSM). Indirect effects via comorbidity were identified. Historical redlining was associated with a lower likelihood of receiving surgery (odds ratio = 0.74, 95% CI = 0.66 to 0.83, and a higher likelihood of receiving palliative care odds ratio = 1.41, 95% CI = 1.04 to 1.91).

CONCLUSION

Historical redlining is associated with differential treatment receipt and poorer survival for ACM and BCSM. Relevant stakeholders should consider historical contexts when designing and implementing equity-focused interventions to reduce BC disparities. Clinicians should advocate for healthier neighborhoods while providing care.

Heatwaves, hospitals and health system resilience in England: a qualitative assessment of frontline perspectives from the hot summer of 2019

OBJECTIVE

To critically assess the impacts of very hot weather on (i) frontline staff in hospitals in England and (ii) on healthcare delivery and patient safety.

STUDY DESIGN

A qualitative study design using key informant semi-structured interviews, preinterview survey and thematic analysis.

SETTING

England.

PARTICIPANTS

14 health professionals in the National Health Service (clinicians and non-clinicians, including facilities managers and emergency preparedness, resilience and response professionals).

RESULTS

Hot weather in 2019 caused significant disruption to health services, facilities and equipment, staff and patient discomfort, and an acute increase in hospital admissions. Levels of awareness varied between clinical and non-clinical staff of the Heatwave Plan for England, Heat-Health Alerts and associated guidance. Response to heatwaves was affected by competing priorities and tensions including infection control, electric fan usage and patient safety.

CONCLUSIONS

Healthcare delivery staff experience difficulty in managing heat risks in hospitals. Priority should be given to workforce development and strategic, long-term planning, prevention and investment to enable staff to prepare and respond, as well as to improve health system resilience to current and future heat-health risks. Further research with a wider, larger cohort is required to develop the evidence base on the impacts, including the costs of those impacts, and to assess the effectiveness and feasibility of interventions. Forming a national picture of health system resilience to heatwaves will support national adaptation planning for health, in addition to informing strategic prevention and effective emergency response.

Advancing Health Equity in Community-Based Climate Action: From Concept to Practice

Despite broad agreement that prioritizing health equity is critical to minimizing the health impacts of climate change, there is a lack of clarity about what advancing health equity means in practice. More than reducing health disparities; it also implies engaging and empowering marginalized communities. We propose a typology of health equity processes, focused on building community agency and power, and then apply it to a nonrepresentative, purposive sample of 48 community-based climate actions (CBCAs) selected from lists of projects funded by foundations and state climate programs and from other sources. All CBCAs were in the United States, community-based, active since 2015 or more recently, engaged in climate mitigation or adaptation, and stated health equity aims. Two team members reviewed project reports to assess the engagement of vulnerable and marginalized populations, agency-building, and transformation of community power relationships. Although 33 CBCAs reported efforts to build community agency, only 19 reported efforts to increase community power. City-led CBCAs showed less emphasis on agency-building and power transformation. This typology can support efforts to advance health equity by providing concrete indicators to diagnose gaps and track progress. (Am J Public Health. 2023;113(2):185-193. https://doi.org/10.2105/AJPH.2022.307143).

The impact of greenspace or nature-based interventions on cardiovascular health or cancer-related outcomes: A systematic review of experimental studies

SIGNIFICANCE

Globally, cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality. While having different etiologies, CVD and cancer are linked by multiple shared risk factors, the presence of which exacerbate adverse outcomes for individuals with either disease. For both pathologies, factors such as poverty, lack of physical activity (PA), poor dietary intake, and climate change increase risk of adverse outcomes. Prior research has shown that greenspaces and other nature-based interventions (NBIs) contribute to improved health outcomes and climate change resilience.

OBJECTIVE

To summarize evidence on the impact of greenspaces or NBIs on cardiovascular health and/or cancer-related outcomes and identify knowledge gaps to inform future research.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and Peer Review of Electronic Search Strategies (PRESS) guidelines, we searched five databases: Web of Science, Scopus, Medline, PsycINFO and GreenFile. Two blinded reviewers used Rayyan AI and a predefined criteria for article inclusion and exclusion. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). This review is registered with PROSPERO, ID # CRD42021231619.

RESULTS & DISCUSSION

Of 2565 articles retrieved, 31 articles met the inclusion criteria, and overall had a low risk of bias. 26 articles studied cardiovascular related outcomes and 5 studied cancer-related outcomes. Interventions were coded into 4 categories: forest bathing, green exercise, gardening, and nature viewing. Outcomes included blood pressure (BP), cancer-related quality of life (QoL) and (more infrequently) biomarkers of CVD risk. Descriptions of findings are presented as well as visual presentations of trends across the findings using RAW graphs. Overall studies included have a low risk of bias; and alluvial chart trends indicated that NBIs may have beneficial effects on CVD and cancer-related outcomes.

CONCLUSIONS & IMPLICATIONS

(1) Clinical implication: Healthcare providers should consider the promotion of nature-based programs to improve health outcomes. (2) Policy implication: There is a need for investment in equitable greenspaces to improve health outcomes and build climate resilient neighborhoods. (3) Research or academic implication: Research partnerships with community-based organizations for a comprehensive study of benefits associated with NBIs should be encouraged to reduce health disparities and ensure intergenerational health equity. There is a need for investigation of the mechanisms by which NBIs impact CVD and exploration of the role of CVD biological markers of inflammation among cancer survivors.

Healthcare Workers' Resilience Toolkit for Disaster Management and Climate Change Adaptation

Climate change has been recognised as a multiplier of risk factors affecting public health. Disruptions caused by natural disasters and other climate-driven impacts are placing increasing demands on healthcare systems. These, in turn, impact the wellness and performance of healthcare workers (HCWs) and hinder the accessibility, functionality and safety of healthcare systems. This study explored factors influencing HCWs' disaster management capabilities with the aim of improving their resilience and adaptive capacity in the face of climate change. In-depth, semi-structured interviews were conducted with thirteen HCWs who dealt with disasters within two hospitals in Queensland, Australia. Analysis of the results identified two significant themes, HCWs' disaster education and HCWs' wellness and needs. The latter comprised five subthemes: HCWs' fear and vulnerability, doubts and uncertainty, competing priorities, resilience and adaptation, and needs assessment. This study developed an 'HCWs Resilience Toolkit', which encourages mindfulness amongst leaders, managers and policymakers about supporting four priority HCWs' needs: 'Wellness', 'Education', 'Resources' and 'Communication'. The authors focused on the 'Education' component to detail recommended training for each of the pre-disaster, mid-disaster and post-disaster phases. The authors conclude the significance of the toolkit, which provides a timely contribution to the healthcare sector amidst ongoing adversity.

Investigating Organizational Learning and Adaptations for Improved Disaster Response Towards "Resilient Hospitals:" An Integrative Literature Review

Background:

For hospitals, learning from disaster response efforts and adapting organizational practices can improve resilience in dealing with future disruptions. However, amidst global disruptions by climate change, the coronavirus disease 2019 (COVID-19) pandemic, and other disasters, hospitals’ ability to cope continues to be highly variable. Hence, there are increasing calls to improve hospitals’ capabilities to grow and adapt towards enhanced resilience.

Aim:

This study aims two-fold: (1) to characterize the current state of knowledge about how hospitals are gaining knowledge from their responses to disasters, and (2) to explore how this knowledge can be applied to inform organizational practices for hospital resilience.

Method:

This study used Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines for data collection and framework for data analysis, Covidence software, and Medical Subject Headings (MeSH) terms and keywords relevant to “hospitals,” “learn,” “disaster response,” and “resilience.” The quality appraisal used an adapted version of the Mixed Methods Assessment Tool (MMAT).

Results:

After applying inclusion and exclusion criteria and quality appraisal, out of the 420 articles retrieved, 22 articles remained for thematic and content analysis. The thematic analysis included the hospital’s functional (operational) and physical (structural and non-structural) sections. The content analysis followed nine learning areas (Governance and Leadership, Planning and Risk Assessment, Surveillance and Monitoring, Communication and Network Engagement, Staff Practices and Safety, Equipment and Resources, Facilities and Infrastructure, Novelty and Innovation, and Learning and Evaluation).

On applying the Deming cycle, only four studies described a completed learning cycle wherein hospitals adapted their organizational structures using the prior experience and evaluation gained in responding to disaster(s).

Conclusions:

There is a gap between hospitals’ organizational learning and institutionalized practice. The conceptualized Hybrid Resilience Learning Framework (HRLF) aims to guide the hospitals’ decision makers in evaluating organizational resilience and knowledge.

In the face of disasters, both the stressful factors and the coping strategies that affect the health care workers (HCWs) should be substantially considered.

Barriers and Enablers for Integrating Public Health Cobenefits in Urban Climate Policy

Urban climate policy offers a significant opportunity to promote improved public health. The evidence around climate and health cobenefits is growing but has yet to translate into widespread integrated policies. This article presents two systematic reviews: first, looking at quantified cobenefits of urban climate policies, where transportation, land use, and buildings emerge as the most studied sectors; and second, looking at review papers exploring the barriers and enablers for integrating these health cobenefits into urban policies. The latter reveals wide agreement concerning the need to improve the evidence base for cobenefits and consensus about the need for greater political will and leadership on this issue. Systems thinking may offer a way forward to help embrace complexity and integrate health cobenefits into decision making. Knowledge coproduction to bring stakeholders together and advance policy-relevant research for urban health will also be required. Action is needed to bring these two important policy agendas together.

Greenspace, Inflammation, Cardiovascular Health, and Cancer: A Review and Conceptual Framework for Greenspace in Cardio-Oncology Research

Cardiovascular disease (CVD) is a leading cause of global morbidity and mortality. Cancer survivors have significantly elevated risk of poor cardiovascular (CV) health outcomes due to close co-morbid linkages and shared risk factors between CVD and cancer, as well as adverse effects of cancer treatment-related cardiotoxicity. CVD and cancer-related outcomes are exacerbated by increased risk of inflammation. Results from different pharmacological interventions aimed at reducing inflammation and risk of major adverse cardiovascular events (MACEs) have been largely mixed to date. Greenspaces have been shown to reduce inflammation and have been associated with CV health benefits, including reduced CVD behavioral risk factors and overall improvement in CV outcomes. Greenspace may, thus, serve to alleviate the CVD burden among cancer survivors. To understand pathways through which greenspace can prevent or reduce adverse CV outcomes among cancer survivors, we review the state of knowledge on associations among inflammation, CVD, cancer, and existing pharmacological interventions. We then discuss greenspace benefits for CV health from ecological to multilevel studies and a few existing experimental studies. Furthermore, we review the relationship between greenspace and inflammation, and we highlight forest bathing in Asian-based studies while presenting existing research gaps in the US literature. Then, we use the socioecological model of health to present an expanded conceptual framework to help fill this US literature gap. Lastly, we present a way forward, including implications for translational science and a brief discussion on necessities for virtual nature and/or exposure to nature images due to the increasing human-nature disconnect; we also offer guidance for greenspace research in cardio-oncology to improve CV health outcomes among cancer survivors.

Exploring, Diversifying and Debating Sustainable Health (Care) Approaches

Today’s sustainability challenges have major implications for human health and health care. At the same time, the way health care is organized and conducted has major sustainability implications. Sustainable health and sustainable health care approaches in research, which engage with health and sustainability as intertwined phenomena, feature increasingly prominently in various literatures, i.e. (i) literature based on the premise of ‘(un)healthy environments result in (un)healthy people’ (e.g., planetary health); (ii) literature on the implications of ecological change for the sustainability of healthcare systems; and (iii) literature on healthcare systems’ sustainability in view of a range of socio-economic factors. However, an integrative elaboration of the manifold relationships between health and sustainability challenges in these literatures is currently lacking. This review paper therefore maps how these three literatures represent intertwinements between health and sustainability challenges, as well as their suggestions to address these challenges. In addition, we explore which themes and questions are pertinent, meaning they have remained largely unaddressed. By performing a qualitative mapping review, we find that calls for structural attention to inequality, to in-and exclusion, and to stakeholder needs and perspectives cut across these three literatures. Furthermore, we identify three cross-cutting key questions that require future research attention. First, how do divergent ideas on what is and divergent ideas on how can that be known give rise to different health- and sustainability visions and pathways? Second, what do abstract problem statements and solutions presented in agenda-setting work look like in practice in specific and diverse empirical contexts across the globe? And third, how are diverse health and sustainability dynamics historically and spatially interconnected? Moreover, we observe that some voices have so far remained largely silent in scientific debates on health and sustainability intertwinements, namely non-expert voices such as patients and citizens, voices from a variety of social scientific and humanities disciplines, voices from relevant domains beyond (environmental) health, and voices from the global South (from non-experts, social scientific and humanities researchers and domains beyond health). We conclude that a focus on inclusive and equitable engagement with intertwined health- and sustainability challenges is imperative. This requires moving away from developing universal knowledge to address generic problems, to foregrounding plurality in terms of problem statements, knowledge, solutions, and the values embedded therein.

Urban Climate Policy and Action through a Health Lens-An Untapped Opportunity

Motivated by a growing recognition of the climate emergency, reflected in the 26th Conference of the Parties (COP26), we outline untapped opportunities to improve health through ambitious climate actions in cities. Health is a primary reason for climate action yet is rarely integrated in urban climate plans as a policy goal. This is a missed opportunity to create sustainable alliances across sectors and groups, to engage a broad set of stakeholders, and to develop structural health promotion. In this statement, we first briefly review the literature on health co-benefits of urban climate change strategies and make the case for health-promoting climate action; we then describe barriers to integrating health in climate action. We found that the evidence-base is often insufficiently policy-relevant to be impactful. Research rarely integrates the complexity of real-world systems, including multiple and dynamic impacts of strategies, and consideration of how decision-making processes contend with competing interests and short-term electoral cycles. Due to siloed-thinking and restrictive funding opportunities, research often falls short of the type of evidence that would be most useful for decision-making, and research outputs can be cryptic to decision makers. As a way forward, we urge researchers and stakeholders to engage in co-production and systems thinking approaches. Partnering across sectors and disciplines is urgently needed so pathways to climate change mitigation and adaptation fully embrace their health-promoting potential and engage society towards the huge transformations needed. This commentary is endorsed by the International Society for Environmental Epidemiology (ISEE) and the International Society for Urban Health (ISUH) and accompanies a sister statement oriented towards stakeholders (published on the societies' websites).

Resilience and Equity in a Time of Crises: Investing in Public Urban Greenspace Is Now More Essential Than Ever in the US and Beyond

The intersecting negative effects of structural racism, COVID-19, climate change, and chronic diseases disproportionately affect racial and ethnic minorities in the US and around the world. Urban populations of color are concentrated in historically redlined, segregated, disinvested, and marginalized neighborhoods with inadequate quality housing and limited access to resources, including quality greenspaces designed to support natural ecosystems and healthy outdoor activities while mitigating urban environmental challenges such as air pollution, heat island effects, combined sewer overflows and poor water quality. Disinvested urban environments thus contribute to health inequity via physical and social environmental exposures, resulting in disparities across numerous health outcomes, including COVID-19 and chronic diseases such as cancer and cardiovascular diseases (CVD). In this paper, we build off an existing conceptual framework and propose another conceptual framework for the role of greenspace in contributing to resilience and health equity in the US and beyond. We argue that strategic investments in public greenspaces in urban neighborhoods impacted by long term economic disinvestment are critically needed to adapt and build resilience in communities of color, with urgency due to immediate health threats of climate change, COVID-19, and endemic disparities in chronic diseases. We suggest that equity-focused investments in public urban greenspaces are needed to reduce social inequalities, expand economic opportunities with diversity in workforce initiatives, build resilient urban ecosystems, and improve health equity. We recommend key strategies and considerations to guide this investment, drawing upon a robust compilation of scientific literature along with decades of community-based work, using strategic partnerships from multiple efforts in Milwaukee Wisconsin as examples of success.

Science Policy to Advance a Climate Change and Health Research Agenda in the United States

Climate change is thought to be one of the greatest public health threats of the 21st century and there has been a tremendous growth in the published literature describing the health implications of climate change over the last decade. Yet, there remain several critical knowledge gaps in this field. Closing these gaps is crucial to developing effective interventions to minimize the health risks from climate change. In this commentary, we discuss policy trends that have influenced the advancement of climate change and health research in the United States context. We then enumerate specific knowledge gaps that could be addressed by policies to advance scientific research. Finally, we describe tools and methods that have not yet been fully integrated into the field, but hold promise for advancing the science. Prioritizing this advancement offers the potential to improve public health-related policies on climate change.

Combined Effect of Hot Weather and Outdoor Air Pollution on Respiratory Health: Literature Review

Association between short-term exposure to ambient air pollution and respiratory health is well documented. At the same time, it is widely known that extreme weather events intrinsically exacerbate air pollution impact. Particularly, hot weather and extreme temperatures during heat waves (HW) significantly affect human health, increasing risks of respiratory mortality and morbidity. Concurrently, a synergistic effect of air pollution and high temperatures can be combined with weather–air pollution interaction during wildfires. The purpose of the current review is to summarize literature on interplay of hot weather, air pollution, and respiratory health consequences worldwide, with the ultimate goal of identifying the most dangerous pollution agents and vulnerable population groups. A literature search was conducted using electronic databases Web of Science, Pubmed, Science Direct, and Scopus, focusing only on peer-reviewed journal articles published in English from 2000 to 2021. The main findings demonstrate that the increased level of PM10 and O3 results in significantly higher rates of respiratory and cardiopulmonary mortality. Increments in PM2.5 and PM10, O3, CO, and NO2 concentrations during high temperature episodes are dramatically associated with higher admissions to hospital in patients with chronic obstructive pulmonary disease, daily hospital emergency transports for asthma, acute and chronic bronchitis, and premature mortality caused by respiratory disease. Excessive respiratory health risk is more pronounced in elderly cohorts and small children. Both heat waves and outdoor air pollution are synergistically linked and are expected to be more serious in the future due to greater climate instability, being a crucial threat to global public health that requires the responsible involvement of researchers at all levels. Sustainable urban planning and smart city design could significantly reduce both urban heat islands effect and air pollution.