Environmental Science › Health, Toxicology and Mutagenesis

Climate Change and Health Impacts

Works Count: 62097

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This cluster of papers explores the impact of climate change on human health, focusing on mortality, heat waves, and infectious diseases. It discusses epidemiological evidence, public health implications, and the vulnerability of populations to extreme temperatures and environmental changes.

Keywords

Climate Change; Human Health; Mortality; Heat Waves; Public Health; Temperature; Epidemiological Evidence; Global Warming; Infectious Diseases; Vulnerability

The environment and disease: association or causation?

2015-01-01

Austin Bradford Hill

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The Effects of Climate Change on Cardiac Health

2015-01-01

Jonathan De Blois , Tord Kjellström , Stefan Agewall +3 more

The earth's climate is changing and increasing ambient heat levels are emerging in large areas of the world. An important cause of this change is the anthropogenic emission of greenhouse … The earth's climate is changing and increasing ambient heat levels are emerging in large areas of the world. An important cause of this change is the anthropogenic emission of greenhouse gases. Climate changes have a variety of negative effects on health, including cardiac health. People with pre-existing medical conditions such as cardiovascular disease (including heart failure), people carrying out physically demanding work and the elderly are particularly vulnerable. This review evaluates the evidence base for the cardiac health consequences of climate conditions, with particular reference to increasing heat exposure, and it also explores the potential further implications.

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Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

2016-10-01

Mohammad H Forouzanfar , Lily Alexander , H Ross Anderson +7 more

BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing … BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context.MethodsWe used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI).FindingsBetween 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa.InterpretationDeclines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden.FundingBill & Melinda Gates Foundation.

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Distributed Lag Linear and Non-Linear Models in R: The Package dlnm.

2011-07-01

Antonio Gasparrini

Distributed lag non-linear models (DLNMs) represent a modeling framework to flexibly describe associations showing potentially non-linear and delayed effects in time series data. This methodology rests on the definition of … Distributed lag non-linear models (DLNMs) represent a modeling framework to flexibly describe associations showing potentially non-linear and delayed effects in time series data. This methodology rests on the definition of a crossbasis, a bi-dimensional functional space expressed by the combination of two sets of basis functions, which specify the relationships in the dimensions of predictor and lags, respectively. This framework is implemented in the R package dlnm, which provides functions to perform the broad range of models within the DLNM family and then to help interpret the results, with an emphasis on graphical representation. This paper offers an overview of the capabilities of the package, describing the conceptual and practical steps to specify and interpret DLNMs with an example of application to real data.

Climate change and human health: Impacts, vulnerability and public health

2006-03-21

Andy Haines , Sari Kovats , Diarmid Campbell‐Lendrum +1 more

Weather-Related Mortality

2009-02-10

Brooke Anderson , Michelle L. Bell

In Brief Background: Many studies have linked weather to mortality; however, role of such critical factors as regional variation, susceptible populations, and acclimatization remain unresolved. Methods: We applied time-series models … In Brief Background: Many studies have linked weather to mortality; however, role of such critical factors as regional variation, susceptible populations, and acclimatization remain unresolved. Methods: We applied time-series models to 107 US communities allowing a nonlinear relationship between temperature and mortality by using a 14-year dataset. Second-stage analysis was used to relate cold, heat, and heat wave effect estimates to community-specific variables. We considered exposure timeframe, susceptibility, age, cause of death, and confounding from pollutants. Heat waves were modeled with varying intensity and duration. Results: Heat-related mortality was most associated with a shorter lag (average of same day and previous day), with an overall increase of 3.0% (95% posterior interval: 2.4%–3.6%) in mortality risk comparing the 99th and 90th percentile temperatures for the community. Cold-related mortality was most associated with a longer lag (average of current day up to 25 days previous), with a 4.2% (3.2%–5.3%) increase in risk comparing the first and 10th percentile temperatures for the community. Mortality risk increased with the intensity or duration of heat waves. Spatial heterogeneity in effects indicates that weather–mortality relationships from 1 community may not be applicable in another. Larger spatial heterogeneity for absolute temperature estimates (comparing risk at specific temperatures) than for relative temperature estimates (comparing risk at community-specific temperature percentiles) provides evidence for acclimatization. We identified susceptibility based on age, socioeconomic conditions, urbanicity, and central air conditioning. Conclusions: Acclimatization, individual susceptibility, and community characteristics all affect heat-related effects on mortality. SUPPLEMENTAL DIGITAL CONTENT AVAILABLE ONLINE IN THE TEXT.

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Distributed lag non‐linear models

2010-05-07

Antonio Gasparrini , Ben Armstrong , Michael G. Kenward

Environmental stressors often show effects that are delayed in time, requiring the use of statistical models that are flexible enough to describe the additional time dimension of the exposure-response relationship. … Environmental stressors often show effects that are delayed in time, requiring the use of statistical models that are flexible enough to describe the additional time dimension of the exposure-response relationship. Here we develop the family of distributed lag non-linear models (DLNM), a modelling framework that can simultaneously represent non-linear exposure-response dependencies and delayed effects. This methodology is based on the definition of a 'cross-basis', a bi-dimensional space of functions that describes simultaneously the shape of the relationship along both the space of the predictor and the lag dimension of its occurrence. In this way the approach provides a unified framework for a range of models that have previously been used in this setting, and new more flexible variants. This family of models is implemented in the package dlnm within the statistical environment R. To illustrate the methodology we use examples of DLNMs to represent the relationship between temperature and mortality, using data from the National Morbidity, Mortality, and Air Pollution Study (NMMAPS) for New York during the period 1987-2000.

Heat Waves in the United States: Mortality Risk during Heat Waves and Effect Modification by Heat Wave Characteristics in 43 U.S. Communities

2010-11-18

G. Brooke Anderson , Michelle L. Bell

Devastating health effects from recent heat waves, and projected increases in frequency, duration, and severity of heat waves from climate change, highlight the importance of understanding health consequences of heat … Devastating health effects from recent heat waves, and projected increases in frequency, duration, and severity of heat waves from climate change, highlight the importance of understanding health consequences of heat waves.We analyzed mortality risk for heat waves in 43 U.S. cities (1987-2005) and investigated how effects relate to heat waves' intensity, duration, or timing in season.Heat waves were defined as ≥ 2 days with temperature ≥ 95th percentile for the community for 1 May through 30 September. Heat waves were characterized by their intensity, duration, and timing in season. Within each community, we estimated mortality risk during each heat wave compared with non-heat wave days, controlling for potential confounders. We combined individual heat wave effect estimates using Bayesian hierarchical modeling to generate overall effects at the community, regional, and national levels. We estimated how heat wave mortality effects were modified by heat wave characteristics (intensity, duration, timing in season).Nationally, mortality increased 3.74% [95% posterior interval (PI), 2.29-5.22%] during heat waves compared with non-heat wave days. Heat wave mortality risk increased 2.49% for every 1°F increase in heat wave intensity and 0.38% for every 1-day increase in heat wave duration. Mortality increased 5.04% (95% PI, 3.06-7.06%) during the first heat wave of the summer versus 2.65% (95% PI, 1.14-4.18%) during later heat waves, compared with non-heat wave days. Heat wave mortality impacts and effect modification by heat wave characteristics were more pronounced in the Northeast and Midwest compared with the South.We found higher mortality risk from heat waves that were more intense or longer, or those occurring earlier in summer. These findings have implications for decision makers and researchers estimating health effects from climate change.

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Heat-Related Deaths during the July 1995 Heat Wave in Chicago

1996-07-11

Jan C. Semenza , Carol H. Rubin , Kenneth H. Falter +4 more

During a record-setting heat wave in Chicago in July 1995, there were at least 700 excess deaths, most of which were classified as heat-related. We sought to determine who was … During a record-setting heat wave in Chicago in July 1995, there were at least 700 excess deaths, most of which were classified as heat-related. We sought to determine who was at greatest risk for heat-related death.

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Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913.

1984-05-12

B. Larsson , Kurt Svärdsudd , Lennart Welin +3 more

In a prospective study of risk factors for ischaemic heart disease 792 54 year old men selected by year of birth (1913) and residence in Gothenburg agreed to attend for … In a prospective study of risk factors for ischaemic heart disease 792 54 year old men selected by year of birth (1913) and residence in Gothenburg agreed to attend for questioning and a battery of anthropometric and other measurements in 1967. Thirteen years later these baseline findings were reviewed in relation to the numbers of men who had subsequently suffered a stroke, ischaemic heart disease, or death from all causes. Neither quintiles nor deciles of initial indices of obesity (body mass index, sum of three skinfold thickness measurements, waist or hip circumference) showed a significant correlation with any of the three end points studied. Statistically significant associations were, however, found between the waist to hip circumference ratio and the occurrence of stroke (p = 0.002) and ischaemic heart disease (p = 0.04). When the confounding effect of body mass index or the sum of three skinfold thicknesses was accounted for the waist to hip circumference ratio was significantly associated with all three end points. This ratio, however, was not an independent long term predictor of these end points when smoking, systolic blood pressure, and serum cholesterol concentration were taken into account. These results indicate that in middle aged men the distribution of fat deposits may be a better predictor of cardiovascular disease and death than the degree of adiposity.

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Managing the health effects of climate change

2009-05-01

Anthony Costello , Mustafa M. El Abbas , Adriana Allen +7 more

Circadian variation and triggers of onset of acute cardiovascular disease.

1989-04-01

James E. Muller , G. Tofler , Peter H. Stone

Information obtained during the past decade suggests the need to reexamine the possibility that the onset of myocardial infarction and sudden cardiac death is frequently triggered by daily activities. The … Information obtained during the past decade suggests the need to reexamine the possibility that the onset of myocardial infarction and sudden cardiac death is frequently triggered by daily activities. The importance of physical or mental stress in triggering onset of coronary thrombosis is supported by the findings that 1) the frequencies of onset of myocardial infarction, sudden cardiac death, and stroke show marked circadian variations with parallel increases in the period from 6:00 AM to noon, 2) transient myocardial ischemia shows a similar morning increase, and episodes are often preceded by mental or physical triggers, 3) a ruptured atherosclerotic plaque, often nonobstructive by itself, lies at the base of most coronary thrombi, 4) a number of physiologic processes that could lead to plaque rupture, a hypercoagulable state or coronary vasoconstriction, are accentuated in the morning, and 5) aspirin and beta-adrenergic blocking agents, which block certain of these processes, have been shown to prevent disease onset. The hypothesis is presented that occlusive coronary thrombosis occurs when 1) an atherosclerotic plaque becomes vulnerable to rupture, 2) mental or physical stress causes the plaque to rupture, and 3) increases in coagulability or vasoconstriction, triggered by daily activities, contribute to complete occlusion of the coronary artery lumen. Recognition of the circadian variation--and the possibility of frequent triggering--of onset of acute disease suggests the need for pharmacologic protection of patients during vulnerable periods, and provides clues to mechanism, the investigations of which may lead to improved methods of prevention.

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Excess mortality related to the August 2003 heat wave in France

2006-03-07

Anne Fouillet , Grégoire Rey , F Laurent +6 more

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Climate Change and Extreme Heat Events

2008-10-11

George Luber , Michael A. McGeehin

Death toll exceeded 70,000 in Europe during the summer of 2003

2007-12-31

Jean‐Marie Robine , Karen Siu‐Lan Cheung , Sophie Roy +4 more

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Consistent geographical patterns of changes in high-impact European heatwaves

2010-05-16

Erich Fischer , Christoph Schär

High ambient temperature and mortality: a review of epidemiologic studies from 2001 to 2008

2009-09-16

Rupa Basu

This review examines recent evidence on mortality from elevated ambient temperature for studies published from January 2001 to December 2008. PubMed was used to search for the following keywords: temperature, … This review examines recent evidence on mortality from elevated ambient temperature for studies published from January 2001 to December 2008. PubMed was used to search for the following keywords: temperature, apparent temperature, heat, heat index, and mortality. The search was limited to the English language and epidemiologic studies. Studies that reported mortality counts or excess deaths following heat waves were excluded so that the focus remained on general ambient temperature and mortality in a variety of locations. Studies focusing on cold temperature effects were also excluded. Thirty-six total studies were presented in three tables: 1) elevated ambient temperature and mortality; 2) air pollutants as confounders and/or effect modifiers of the elevated ambient temperature and mortality association; and 3) vulnerable subgroups of the elevated ambient temperature-mortality association. The evidence suggests that particulate matter with less than 10 um in aerodynamic diameter and ozone may confound the association, while ozone was an effect modifier in the warmer months in some locations. Nonetheless, the independent effect of temperature and mortality was withheld. Elevated temperature was associated with increased risk for those dying from cardiovascular, respiratory, cerebrovascular, and some specific cardiovascular diseases, such as ischemic heart disease, congestive heart failure, and myocardial infarction. Vulnerable subgroups also included: Black racial/ethnic group, women, those with lower socioeconomic status, and several age groups, particularly the elderly over 65 years of age as well as infants and young children. Many of these outcomes and vulnerable subgroups have only been identified in recent studies and varied by location and study population. Thus, region-specific policies, especially in urban areas, are vital to the mitigation of heat-related deaths.

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Health and climate change: policy responses to protect public health

2015-06-23

Nick Watts , W. Neil Adger , Paolo Agnolucci +7 more

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Neighborhood microclimates and vulnerability to heat stress

2006-09-26

Sharon L. Harlan , Anthony J. Brazel , Lela Prashad +2 more

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Climate change and human health: present and future risks

2006-02-10

Anthony J. McMichael , Rosalie Woodruff , Simon Hales

Temperature and Mortality in 11 Cities of the Eastern United States

2002-01-01

Frank C. Curriero , Karlyn S. Heiner , Jonathan M. Samet +3 more

Episodes of extremely hot or cold temperatures are associated with increased mortality. Time-series analyses show an association between temperature and mortality across a range of less extreme temperatures. In this … Episodes of extremely hot or cold temperatures are associated with increased mortality. Time-series analyses show an association between temperature and mortality across a range of less extreme temperatures. In this paper, the authors describe the temperature-mortality association for 11 large eastern US cities in 1973-1994 by estimating the relative risks of mortality using log-linear regression analysis for time-series data and by exploring city characteristics associated with variations in this temperature-mortality relation. Current and recent days' temperatures were the weather components most strongly predictive of mortality, and mortality risk generally decreased as temperature increased from the coldest days to a certain threshold temperature, which varied by latitude, above which mortality risk increased as temperature increased. The authors also found a strong association of the temperature-mortality relation with latitude, with a greater effect of colder temperatures on mortality risk in more-southern cities and of warmer temperatures in more-northern cities. The percentage of households with air conditioners in the south and heaters in the north, which serve as indicators of socioeconomic status of the city population, also predicted weather-related mortality. The model developed in this analysis is potentially useful for projecting the consequences of climate-change scenarios and offering insights into susceptibility to the adverse effects of weather.

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Heat Stress and Public Health: A Critical Review

2007-11-22

Sari Kovats , Shakoor Hajat

Heat is an environmental and occupational hazard. The prevention of deaths in the community caused by extreme high temperatures (heat waves) is now an issue of public health concern. The … Heat is an environmental and occupational hazard. The prevention of deaths in the community caused by extreme high temperatures (heat waves) is now an issue of public health concern. The risk of heat-related mortality increases with natural aging, but persons with particular social and/or physical vulnerability are also at risk. Important differences in vulnerability exist between populations, depending on climate, culture, infrastructure (housing), and other factors. Public health measures include health promotion and heat wave warning systems, but the effectiveness of acute measures in response to heat waves has not yet been formally evaluated. Climate change will increase the frequency and the intensity of heat waves, and a range of measures, including improvements to housing, management of chronic diseases, and institutional care of the elderly and the vulnerable, will need to be developed to reduce health impacts.

The urban heat island and its impact on heat waves and human health in Shanghai

2009-08-31

Jianguo Tan , Youfei Zheng , Xu Tang +7 more

The ecology of climate change and infectious diseases

2009-03-31

Kevin D. Lafferty

The projected global increase in the distribution and prevalence of infectious diseases with climate change suggests a pending societal crisis. The subject is increasingly attracting the attention of health professionals … The projected global increase in the distribution and prevalence of infectious diseases with climate change suggests a pending societal crisis. The subject is increasingly attracting the attention of health professionals and climate-change scientists, particularly with respect to malaria and other vector-transmitted human diseases. The result has been the emergence of a crisis discipline, reminiscent of the early phases of conservation biology. Latitudinal, altitudinal, seasonal, and interannual associations between climate and disease along with historical and experimental evidence suggest that climate, along with many other factors, can affect infectious diseases in a nonlinear fashion. However, although the globe is significantly warmer than it was a century ago, there is little evidence that climate change has already favored infectious diseases. While initial projections suggested dramatic future increases in the geographic range of infectious diseases, recent models predict range shifts in disease distributions, with little net increase in area. Many factors can affect infectious disease, and some may overshadow the effects of climate.

Relation between Elevated Ambient Temperature and Mortality: A Review of the Epidemiologic Evidence

2002-12-01

Rupa Basu

The effect of elevated temperature on mortality is a public health threat of considerable magnitude. Every year, a large number of hospitalizations and deaths occur in association with exposure to … The effect of elevated temperature on mortality is a public health threat of considerable magnitude. Every year, a large number of hospitalizations and deaths occur in association with exposure to elevated ambient temperatures (1, 2). An average of 400 deaths annually are counted as directly related to heat in the United States, with the highest death rates occurring in persons aged 65 years or more (3). The actual magnitude of heat-related mortality may be notably greater than what has been reported, since we do not have widely accepted criteria for determining heat-related death (4, 5–7), and heat may not be listed on the death certificate as causing or contributing to death. Persons living in urban environments may be at particularly increased risk for mortality from ambient heat exposure, since urban areas typically have higher heat indexes (combinations of temperature and humidity (8)) than surrounding suburban or rural areas, a phenomenon known as the “urban heat island effect” (9). Moreover, urban areas retain heat during the night more efficiently (10). Thus, as the US population becomes more urbanized and the number of elderly people continues to increase (11), the threat of heat-related mortality will probably become more severe. Many of these deaths may be preventable with adequate warning and an appropriate response to heat emergencies, but preventive efforts are complicated by the short time interval that may elapse between high temperature exposure and death. Thus, prevention programs must be based around prospective and rapid identification of high-risk conditions and persons. We carried out this review to assess the current epidemiologic evidence available for this purpose.

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Impact of regional climate change on human health

2005-11-01

Jonathan A. Patz , Diarmid Campbell‐Lendrum , Tracey Holloway +1 more

Housing and Health: Time Again for Public Health Action

2002-05-01

JAMES KRIEGER , D L Higgins

Poor housing conditions are associated with a wide range of health conditions, including respiratory infections, asthma, lead poisoning, injuries, and mental health. Addressing housing issues offers public health practitioners an … Poor housing conditions are associated with a wide range of health conditions, including respiratory infections, asthma, lead poisoning, injuries, and mental health. Addressing housing issues offers public health practitioners an opportunity to address an important social determinant of health. Public health has long been involved in housing issues. In the 19th century, health officials targeted poor sanitation, crowding, and inadequate ventilation to reduce infectious diseases as well as fire hazards to decrease injuries. Today, public health departments can employ multiple strategies to improve housing, such as developing and enforcing housing guidelines and codes, implementing “Healthy Homes” programs to improve indoor environmental quality, assessing housing conditions, and advocating for healthy, affordable housing. Now is the time for public health to create healthier homes by confronting substandard housing.

Mortality risk attributable to high and low ambient temperature: a multicountry observational study

2015-05-21

Antonio Gasparrini , Yuming Guo , Masahiro Hashizume +7 more

BackgroundAlthough studies have provided estimates of premature deaths attributable to either heat or cold in selected countries, none has so far offered a systematic assessment across the whole temperature range … BackgroundAlthough studies have provided estimates of premature deaths attributable to either heat or cold in selected countries, none has so far offered a systematic assessment across the whole temperature range in populations exposed to different climates. We aimed to quantify the total mortality burden attributable to non-optimum ambient temperature, and the relative contributions from heat and cold and from moderate and extreme temperatures.MethodsWe collected data for 384 locations in Australia, Brazil, Canada, China, Italy, Japan, South Korea, Spain, Sweden, Taiwan, Thailand, UK, and USA. We fitted a standard time-series Poisson model for each location, controlling for trends and day of the week. We estimated temperature–mortality associations with a distributed lag non-linear model with 21 days of lag, and then pooled them in a multivariate metaregression that included country indicators and temperature average and range. We calculated attributable deaths for heat and cold, defined as temperatures above and below the optimum temperature, which corresponded to the point of minimum mortality, and for moderate and extreme temperatures, defined using cutoffs at the 2·5th and 97·5th temperature percentiles.FindingsWe analysed 74 225 200 deaths in various periods between 1985 and 2012. In total, 7·71% (95% empirical CI 7·43–7·91) of mortality was attributable to non-optimum temperature in the selected countries within the study period, with substantial differences between countries, ranging from 3·37% (3·06 to 3·63) in Thailand to 11·00% (9·29 to 12·47) in China. The temperature percentile of minimum mortality varied from roughly the 60th percentile in tropical areas to about the 80–90th percentile in temperate regions. More temperature-attributable deaths were caused by cold (7·29%, 7·02–7·49) than by heat (0·42%, 0·39–0·44). Extreme cold and hot temperatures were responsible for 0·86% (0·84–0·87) of total mortality.InterpretationMost of the temperature-related mortality burden was attributable to the contribution of cold. The effect of days of extreme temperature was substantially less than that attributable to milder but non-optimum weather. This evidence has important implications for the planning of public-health interventions to minimise the health consequences of adverse temperatures, and for predictions of future effect in climate-change scenarios.FundingUK Medical Research Council.

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Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health

2015-07-16

Sarah Whitmee , Andy Haines , Chris Beyrer +7 more

Far-reaching changes to the structure and function of the Earth's natural systems represent a growing threat to human health. And yet, global health has mainly improved as these changes have … Far-reaching changes to the structure and function of the Earth's natural systems represent a growing threat to human health. And yet, global health has mainly improved as these changes have gathered pace. What is the explanation? As a Commission, we are deeply concerned that the explanation is straightforward and sobering: we have been mortgaging the health of future generations to realise economic and development gains in the present. By unsustainably exploiting nature's resources, human civilisation has flourished but now risks substantial health effects from the degradation of nature's life support systems in the future. Health effects from changes to the environment including climatic change, ocean acidification, land degradation, water scarcity, overexploitation of fisheries, and biodiversity loss pose serious challenges to the global health gains of the past several decades and are likely to become increasingly dominant during the second half of this century and beyond. These striking trends are driven by highly inequitable, inefficient, and unsustainable patterns of resource consumption and technological development, together with population growth. We identify three categories of challenges that have to be addressed to maintain and enhance human health in the face of increasingly harmful environmental trends. Firstly, conceptual and empathy failures (imagination challenges), such as an over-reliance on gross domestic product as a measure of human progress, the failure to account for future health and environmental harms over present day gains, and the disproportionate effect of those harms on the poor and those in developing nations. Secondly, knowledge failures (research and information challenges), such as failure to address social and environmental drivers of ill health, a historical scarcity of transdisciplinary research and funding, together with an unwillingness or inability to deal with uncertainty within decision making frameworks. Thirdly, implementation failures (governance challenges), such as how governments and institutions delay recognition and responses to threats, especially when faced with uncertainties, pooled common resources, and time lags between action and effect. Although better evidence is needed to underpin appropriate policies than is available at present, this should not be used as an excuse for inaction. Substantial potential exists to link action to reduce environmental damage with improved health outcomes for nations at all levels of economic development. This Commission identifies opportunities for action by six key constituencies: health professionals, research funders and the academic community, the UN and Bretton Woods bodies, governments, investors and corporate reporting bodies, and civil society organisations. Depreciation of natural capital and nature's subsidy should be accounted for so that economy and nature are not falsely separated. Policies should balance social progress, environmental sustainability, and the economy. To support a world population of 9–10 billion people or more, resilient food and agricultural systems are needed to address both undernutrition and overnutrition, reduce waste, diversify diets, and minimise environmental damage. Meeting the need for modern family planning can improve health in the short term—eg, from reduced maternal mortality and reduced pressures on the environment and on infrastructure. Planetary health offers an unprecedented opportunity for advocacy of global and national reforms of taxes and subsidies for many sectors of the economy, including energy, agriculture, water, fisheries, and health. Regional trade treaties should act to further incorporate the protection of health in the near and long term. Several essential steps need to be taken to transform the economy to support planetary health. These steps include a reduction of waste through the creation of products that are more durable and require less energy and materials to manufacture than those often produced at present; the incentivisation of recycling, reuse, and repair; and the substitution of hazardous materials with safer alternatives. Key messages1The concept of planetary health is based on the understanding that human health and human civilisation depend on flourishing natural systems and the wise stewardship of those natural systems. However, natural systems are being degraded to an extent unprecedented in human history.2Environmental threats to human health and human civilisation will be characterised by surprise and uncertainty. Our societies face clear and potent dangers that require urgent and transformative actions to protect present and future generations.3The present systems of governance and organisation of human knowledge are inadequate to address the threats to planetary health. We call for improved governance to aid the integration of social, economic, and environmental policies and for the creation, synthesis, and application of interdisciplinary knowledge to strengthen planetary health.4Solutions lie within reach and should be based on the redefinition of prosperity to focus on the enhancement of quality of life and delivery of improved health for all, together with respect for the integrity of natural systems. This endeavour will necessitate that societies address the drivers of environmental change by promoting sustainable and equitable patterns of consumption, reducing population growth, and harnessing the power of technology for change. 1The concept of planetary health is based on the understanding that human health and human civilisation depend on flourishing natural systems and the wise stewardship of those natural systems. However, natural systems are being degraded to an extent unprecedented in human history.2Environmental threats to human health and human civilisation will be characterised by surprise and uncertainty. Our societies face clear and potent dangers that require urgent and transformative actions to protect present and future generations.3The present systems of governance and organisation of human knowledge are inadequate to address the threats to planetary health. We call for improved governance to aid the integration of social, economic, and environmental policies and for the creation, synthesis, and application of interdisciplinary knowledge to strengthen planetary health.4Solutions lie within reach and should be based on the redefinition of prosperity to focus on the enhancement of quality of life and delivery of improved health for all, together with respect for the integrity of natural systems. This endeavour will necessitate that societies address the drivers of environmental change by promoting sustainable and equitable patterns of consumption, reducing population growth, and harnessing the power of technology for change. Despite present limitations, the Sustainable Development Goals provide a great opportunity to integrate health and sustainability through the judicious selection of relevant indicators relevant to human wellbeing, the enabling infrastructure for development, and the supporting natural systems, together with the need for strong governance. The landscape, ecosystems, and the biodiversity they contain can be managed to protect natural systems, and indirectly, reduce human disease risk. Intact and restored ecosystems can contribute to resilience (see panel 1 for glossary of terms used in this report), for example, through improved coastal protection (eg, through wave attenuation) and the ability of floodplains and greening of river catchments to protect from river flooding events by diverting and holding excess water.Panel 1GlossaryHolocene1International Commission on StratigraphyInternational stratigraphic chart.http://www.stratigraphy.org/ICSchart/ChronostratChart2013-01.pdfDate: 2013Google ScholarA geological epoch that began about 11 700 years ago and encompasses most of the time period during which humanity has grown and developed, including all its written history and development of major civilisations.Anthropocene2Crutzen PJ Geology of mankind.Nature. 2002; 415: 23Crossref PubMed Scopus (1931) Google ScholarThe proposed name for a new geological epoch demarcated as the time when human activities began to have a substantial global effect on the Earth's systems. The Anthropocene has to be yet formally recognised as a new geological epoch and several dates have been put forward to mark its beginning.Ecosystem3Millennium Ecosystem AssessmentEcosystems and human wellbeing: health synthesis.in: Corvalan C Hales S McMichael AJ Island Press, Washington DC2005Google ScholarA dynamic complex of plant, animal, and microorganism communities and the non-living environment acting as a functional unit.Ecosystem services4UKNEAThe UK National Ecosystem Assessment: technical report. United Nations Environment Programme's World Conservation Monitoring Centre, Cambridge, UK2011Google ScholarThe benefits provided by ecosystems that contribute to making human life both possible and worth living. Examples of ecosystem services include products such as food and clean water, regulation of floods, soil erosion, and disease outbreaks, and non-material benefits such as recreational and spiritual benefits in natural areas. The term services is usually used to encompass the tangible and intangible benefits that human beings obtain from ecosystems, which are sometimes separated into goods and services.Biodiversity5Millennium Ecosystem AssessmentBiodiversity.in: Mace G Masundire H Baillie J Millennium ecosystem assessment: current state and trends: findings of the condition and trends working group ecosystems and human well-being. Island Press, Washington, DC2005Google ScholarAn abbreviation of biological diversity; biodiversity means the variability among living organisms from all sources, including inter alia, terrestrial, marine, and other aquatic ecosystems and the ecological complexes of which they are part. This variability includes diversity within species, between species, and of ecosystems.Wetland6RamsarConvention on wetlands of international importance especially as waterfowl habitat 1971. Iran, Feb 2, 1971. As amended by the protocol of Dec 3, 1982, and the amendments of May 28, 1987.http://portal.unesco.org/en/ev.php-URL_ID=15398&URL_DO=DO_TOPIC&URL_SECTION=201.htmlGoogle ScholarThe Ramsar Convention defines wetlands as “areas of marsh, fen, peatland or water, whether natural or artificial, permanent or temporary, with water that is static or flowing, fresh, brackish or salt, including areas of marine water the depth of which at low tide does not exceed six metres”.Representative Concentration Pathway (RCP)7IPCCClimate change 2013. The Physical Science Basis Working Group I contribution to the fifth assessment report of the Intergovernmental Panel on Climate Change. Cambridge University Press, Intergovernmental Panel on Climate Change, Cambridge, UK and New York, USA2013Google ScholarRCPs are trajectories of the concentrations of greenhouse gases in the atmosphere consistent with a range of possible future emissions. For the Fifth Assessment Report of Intergovernmental Panel on Climate Change, the scientific community has defined a set of four RCPs. They are identified by their approximate total radiative forcing (ie, warming effect) in the year 2100 relative to 1750. RCP 8·5 is a pathway with very high greenhouse gas emissions, but such emissions are in line with present trends.Social–ecological systems8Stockholm Resilience CentreResilience dictionary.http://www.stockholmresilience.org/21/research/what-is-resilience/resilience-dictionary.htmlDate: 2015Google ScholarNatural systems do not exist without people and social systems cannot exist totally in isolation from nature. These systems are truly interconnected and coevolve across spatial and temporal scales.REDD+9UN-REDD ProgrammeAbout REDD+.http://www.un-redd.org/aboutreddDate: 2015Google ScholarReducing Emissions from Deforestation and Forest Degradation (REDD) tries to assign a financial value to the carbon stored in trees to help developing countries invest in low-carbon paths to sustainable development. REDD+ includes an added focus on conservation, sustainable management of forests, and enhancement of forest carbon stocks.Externalities10Buchanan JM Stubblebine WC Externality.Economica. 1962; 29: 371-384Crossref Google ScholarA benefit or cost that affects an individual or group of people who did not choose to incur that benefit or cost.Circular economy11European CommissionTowards a circular economy: a zero waste programme for Europe.http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:52014DC0398Date: 2014Google ScholarA global economic model that decouples economic growth and development from the consumption of finite resources. Circular economy systems keep products in use for as long as possible, allow for the recycling of end products, and eliminate waste.State shift12Rocha JC Biggs R Peterson GD Regime shifts: what are they and why do they matter?.http://www.regimeshifts.org/datasets-resources/Date: 2014Google ScholarLarge, lasting changes in the structure and function of social–ecological systems, with substantial impacts on the ecosystem services provided by these systems.Resilience8Stockholm Resilience CentreResilience dictionary.http://www.stockholmresilience.org/21/research/what-is-resilience/resilience-dictionary.htmlDate: 2015Google Scholar, 13Rodin J The resilience dividend: being strong in a world where things go wrong. PublicAffairs, New York2014Google Scholar“the capacity of any entity—an individual, a community, an organization, or a natural system—to prepare for disruptions, to recover from shocks and stresses, and to adapt and grow from a disruptive experience.” Holocene1International Commission on StratigraphyInternational stratigraphic chart.http://www.stratigraphy.org/ICSchart/ChronostratChart2013-01.pdfDate: 2013Google Scholar A geological epoch that began about 11 700 years ago and encompasses most of the time period during which humanity has grown and developed, including all its written history and development of major civilisations. Anthropocene2Crutzen PJ Geology of mankind.Nature. 2002; 415: 23Crossref PubMed Scopus (1931) Google Scholar The proposed name for a new geological epoch demarcated as the time when human activities began to have a substantial global effect on the Earth's systems. The Anthropocene has to be yet formally recognised as a new geological epoch and several dates have been put forward to mark its beginning. Ecosystem3Millennium Ecosystem AssessmentEcosystems and human wellbeing: health synthesis.in: Corvalan C Hales S McMichael AJ Island Press, Washington DC2005Google Scholar A dynamic complex of plant, animal, and microorganism communities and the non-living environment acting as a functional unit. Ecosystem services4UKNEAThe UK National Ecosystem Assessment: technical report. United Nations Environment Programme's World Conservation Monitoring Centre, Cambridge, UK2011Google Scholar The benefits provided by ecosystems that contribute to making human life both possible and worth living. Examples of ecosystem services include products such as food and clean water, regulation of floods, soil erosion, and disease outbreaks, and non-material benefits such as recreational and spiritual benefits in natural areas. The term services is usually used to encompass the tangible and intangible benefits that human beings obtain from ecosystems, which are sometimes separated into goods and services. Biodiversity5Millennium Ecosystem AssessmentBiodiversity.in: Mace G Masundire H Baillie J Millennium ecosystem assessment: current state and trends: findings of the condition and trends working group ecosystems and human well-being. Island Press, Washington, DC2005Google Scholar An abbreviation of biological diversity; biodiversity means the variability among living organisms from all sources, including inter alia, terrestrial, marine, and other aquatic ecosystems and the ecological complexes of which they are part. This variability includes diversity within species, between species, and of ecosystems. Wetland6RamsarConvention on wetlands of international importance especially as waterfowl habitat 1971. Iran, Feb 2, 1971. As amended by the protocol of Dec 3, 1982, and the amendments of May 28, 1987.http://portal.unesco.org/en/ev.php-URL_ID=15398&URL_DO=DO_TOPIC&URL_SECTION=201.htmlGoogle Scholar The Ramsar Convention defines wetlands as “areas of marsh, fen, peatland or water, whether natural or artificial, permanent or temporary, with water that is static or flowing, fresh, brackish or salt, including areas of marine water the depth of which at low tide does not exceed six metres”. Representative Concentration Pathway (RCP)7IPCCClimate change 2013. The Physical Science Basis Working Group I contribution to the fifth assessment report of the Intergovernmental Panel on Climate Change. Cambridge University Press, Intergovernmental Panel on Climate Change, Cambridge, UK and New York, USA2013Google Scholar RCPs are trajectories of the concentrations of greenhouse gases in the atmosphere consistent with a range of possible future emissions. For the Fifth Assessment Report of Intergovernmental Panel on Climate Change, the scientific community has defined a set of four RCPs. They are identified by their approximate total radiative forcing (ie, warming effect) in the year 2100 relative to 1750. RCP 8·5 is a pathway with very high greenhouse gas emissions, but such emissions are in line with present trends. Social–ecological systems8Stockholm Resilience CentreResilience dictionary.http://www.stockholmresilience.org/21/research/what-is-resilience/resilience-dictionary.htmlDate: 2015Google Scholar Natural systems do not exist without people and social systems cannot exist totally in isolation from nature. These systems are truly interconnected and coevolve across spatial and temporal scales. REDD+9UN-REDD ProgrammeAbout REDD+.http://www.un-redd.org/aboutreddDate: 2015Google Scholar Reducing Emissions from Deforestation and Forest Degradation (REDD) tries to assign a financial value to the carbon stored in trees to help developing countries invest in low-carbon paths to sustainable development. REDD+ includes an added focus on conservation, sustainable management of forests, and enhancement of forest carbon stocks. Externalities10Buchanan JM Stubblebine WC Externality.Economica. 1962; 29: 371-384Crossref Google Scholar A benefit or cost that affects an individual or group of people who did not choose to incur that benefit or cost. Circular economy11European CommissionTowards a circular economy: a zero waste programme for Europe.http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:52014DC0398Date: 2014Google Scholar A global economic model that decouples economic growth and development from the consumption of finite resources. Circular economy systems keep products in use for as long as possible, allow for the recycling of end products, and eliminate waste. State shift12Rocha JC Biggs R Peterson GD Regime shifts: what are they and why do they matter?.http://www.regimeshifts.org/datasets-resources/Date: 2014Google Scholar Large, lasting changes in the structure and function of social–ecological systems, with substantial impacts on the ecosystem services provided by these systems. Resilience8Stockholm Resilience CentreResilience dictionary.http://www.stockholmresilience.org/21/research/what-is-resilience/resilience-dictionary.htmlDate: 2015Google Scholar, 13Rodin J The resilience dividend: being strong in a world where things go wrong. PublicAffairs, New York2014Google Scholar “the capacity of any entity—an individual, a community, an organization, or a natural system—to prepare for disruptions, to recover from shocks and stresses, and to adapt and grow from a disruptive experience.” The growth in urban populations emphasises the importance of policies to improve health and the urban environment, such as through reduced air pollution, increased physical activity, provision of green space, and urban planning to prevent sprawl and decrease the magnitude of urban heat islands. Transdisciplinary research activities and capacity need substantial and urgent expansion. Present research limitations should not delay action. In situations where technology and knowledge can deliver win–win solutions and co-benefits, rapid scale-up can be achieved if researchers move ahead and assess the implementation of potential solutions. Recent scientific investments towards understanding non-linear state shifts in ecosystems are very important, but in the absence of improved understanding and predictability of such changes, efforts to improve resilience for human health and adaptation strategies remain a priority. The creation of integrated surveillance systems that collect rigorous health, socioeconomic, and environmental data for defined populations over long time periods can provide early detection of emerging disease outbreaks or changes in nutrition and non-communicable disease burden. The improvement of risk communication to policy makers and the public and the support of policy makers to make evidence-informed decisions can be helped by an increased capacity to do systematic reviews and the provision of rigorous policy briefs. Health professionals have an essential role in the achievement of planetary health: working across sectors to integrate policies that advance health and environmental sustainability, tackling health inequities, reducing the environmental impacts of health systems, and increasing the resilience of health systems and populations to environmental change. Humanity can be stewarded successfully through the 21st century by addressing the unacceptable inequities in health and wealth within the environmental limits of the Earth, but this will require the generation of new knowledge, implementation of wise policies, decisive action, and inspirational leadership. By most metrics, human health is better today than at any time in history. Life expectancy has soared from 47 years in 1950–1955, to 69 years in 2005–2010. Death rates in children younger than 5 years of age worldwide decreased substantially from 214 per thousand live births in 1950–1955 to 59 in 2005–2010.14You D Hug L Chen Y Wardlaw T Newby H Levels and trends in child mortality. United Nations Inter-agency Group for Child Mortality Estimation, New York2014Google Scholar, 15Population Division of the Department of Economic and Social Affairs of the UN SecretariatWorld population prospects: the 2012 revision. United Nations, New York2013Crossref Google Scholar Human beings have been supremely successful, staging a “great escape” from extreme deprivation in the past 250 years.16Deaton A The great escape: health, wealth, and the origins of inequality. Princeton University Press, Princeton2013Google Scholar The total number of people living in extreme poverty has fallen by 0·7 billion over the past 30 years, despite an increase in the total population of poor countries of about 2 billion.17Olinto P Beegle K Sobrado C Uematsu H The state of the poor: where are the poor, where is extreme poverty harder to end, and what is the current profile of the world's poor? The World Bank, Washington, DC2013Google Scholar This escape from poverty has been accompanied by unparalleled advances in public health, health care, education, human rights legislation, and technological development that have brought great benefits, albeit inequitably, to humanity. Humanity's progress has been supported by the Earth's ecological and biophysical systems. The Earth's atmosphere, oceans, and important ecosystems such as forests, wetlands, and tundra help to maintain a constant climate, provide clean air, recycle nutrients such as nitrogen and phosphorus, and regulate the world's water cycle, giving humanity freshwater for drinking and sanitation.3Millennium Ecosystem AssessmentEcosystems and human wellbeing: health synthesis.in: Corvalan C Hales S McMichael AJ Island Press, Washington DC2005Google Scholar The land, seas, and rivers, and the plants and animals they contain, also provide many direct goods and benefits—chiefly food, fuel, timber, and medicinal compounds (figure 1). Alongside the development of public health, the development of agriculture and industry have been major drivers of human success, harnessing the ability of the Earth to provide sustenance, shelter, and energy—underpinning the expansion of civilisation.18Sukhdev P Wittmer H Schröter-Schlaack C et al.Mainstreaming the economics of nature: a synthesis of the approach, conclusions and recommendations of TEEB. The Economics of Ecosystems and Biodiversity, Geneva2010Google Scholar To achieve the gains in nutrition, health, and energy use needed to reach a population of more than 7 billion people has required substantial changes in many of these systems, often affecting their structure and function at a cost to their ability to provide other vital services and to function in ways on which humanity has relied throughout history.19DeFries R Foley JA Asner GP Land-use choices: balancing human needs and ecosystem function.Front Ecol Environ. 2004; 2: 249-257Crossref Google Scholar In essence, humanity has traded off many of the Earth's supportive and regulating processes to feed and fuel human population growth and development.20Bennett EM Peterson GD Gordon LJ Understanding relationships among multiple ecosystem services.Ecol Lett. 2009; 12: 1394-1404Crossref PubMed Scopus (1166) Google Scholar The scale of human alteration of the natural world is difficult to overstate (figure 2). Human beings have converted about a third of the ice-free and desert-free land surface of the planet to cropland or pasture25Foley JA Monfreda C Ramankutty N Zaks D Our share of the planetary pie.Proc Natl Acad Sci USA. 2007; 104: 12585-12586Crossref PubMed Scopus (75) Google Scholar and annually roughly half of all accessible freshwater is appropriated for human use.22Steffen W Broadgate W Deutsch L Gaffney O Ludwig C The trajectory of the Anthropocene: the great acceleration.The Anthropocene Review. 2015; 2: 81-98Crossref Google Scholar Since 2000, human beings have cut down more than 2·3 million km2 of primary forest.26Hansen MC Potapov PV Moore R et al.High-resolution global maps of 21st-century forest cover change.Science. 2013; 342: 850-853Crossref PubMed Scopus (4290) Google Scholar About 90% of monitored fisheries are harvested at, or beyond, maximum sustainable yield limits.27FAOThe state of world fisheries and aquaculture—opportunities and challenges. Food and Agriculture Organization, Rome2014Google Scholar In the quest for energy and control over water resources, humanity has dammed more than 60% of the world's rivers,28World Commission on DamsDams and development: a new framework for decision-making.http://www.unep.org/dams/WCD/report/WCD_DAMS%20report.pdfDate: November, 2000Google Scholar affecting in excess of 0·5 million km of river.29Lehner B Liermann CR Revenga C et al.High-resolution mapping of the world's reservoirs and dams for sustainable river-flow management.Front Ecol Environ. 2011; 9: 494-502Crossref Scopus (0) Google Scholar Humanity is driving species to extinction at a rate that is more than 100 times that observed in the fossil record30Pimm SL Jenkins CN Abell R et al.The biodiversity of species and their rates of extinction, distribution, and protection.Science. 2014; 344: 1246752Crossref PubMed Scopus (1212) Google Scholar and many remaining species are decreasing in number. The 2014 Living Planet Report24WWFLiving planet report 2014: species and spaces, people and places. World Wide Fund for Nature, Gland, Switzerland2014Google Scholar estimates that vertebrate species have, on average, had their population sizes cut in half in the past 45 years. The concentrations of major greenhouse gases—carbon dioxide, methane, and nitrous oxide—are at their highest levels for at least the past 800 000 years.7IPCCClimate change 2013. The Physical Science Basis Working Group I contribution to the fifth assessment report of the Intergovernmental Panel on Climate Change. Cambridge University Press, Intergovernmental Panel on Climate Change, Cambridge, UK and New York, USA2013Google Scholar As a consequence of these actions, humanity has become a primary determinant of Earth's biophysical conditions, giving rise to a new term for the present geological epoch, the Anthropocene (panel 1).2Crutzen PJ Geology of mankind.Nature. 2002; 415: 23Crossref PubMed Scopus (1931) Google Scholar In 2005, a landmark study by the Millennium Ecosystem Assessment (MEA) estimated that 60% of ecosystem services examined, from regulation of air quality to purification of water, are being degraded or used unsustainably (figure 2).3Millennium Ecosystem AssessmentEcosystems and human wellbeing: health synthesis.in: Corvalan C Hales S McMichael AJ Island Press, Washington DC2005Google Scholar The authors of the MEA warned that “the ability of the planet's ecosystems to sustain future generations can no longer be taken for granted”.31Millennium Ecosystem AssessmentLiving beyond our means. Natural assets and human well-being. Statement from the Board.in: Millennium Ecosystem Assessment Board Millennium Ecosystem Assessment, Washington, DC2005Google Scholar In 2006, a report published by WHO estimated that about a quarter of the global disease burden and more than a third of the burden in children was attributable to modifiable environmental factors.32Prüss-Üstün A Corvalán C Preventing disease through healthy environments. Towards an estimate of the environmental burden of disease. World Health

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Circadian Variation in the Frequency of Onset of Acute Myocardial Infarction

1985-11-21

James E. Muller , Peter H. Stone , Zoltan G. Turi +7 more

To determine whether the onset of myocardial infarction occurs randomly throughout the day, we analyzed the time of onset of pain in 2999 patients admitted with myocardial infarction. A marked … To determine whether the onset of myocardial infarction occurs randomly throughout the day, we analyzed the time of onset of pain in 2999 patients admitted with myocardial infarction. A marked circadian rhythm in the frequency of onset was detected, with a peak from 6 a.m. to noon (P<0.01). In 703 of the patients, the time of the first elevation in the plasma creatine kinase MB (CK-MB) level could be used to time the onset of myocardial infarction objectively. CK-MB—estimated timing confirmed the existence of a circadian rhythm, with a threefold increase in the frequency of onset of myocardial infarction at peak (9 a.m.) as compared with trough (11 p.m.) periods. The circadian rhythm was not detected in patients receiving beta-adrenergic blocking agents before myocardial infarction but was present in those not receiving such therapy. If coronary arteries become vulnerable to occlusion when the intima covering an atherosclerotic plaque is disrupted, the circadian timing of myocardial infarction may result from a variation in the tendency to thrombosis. If the rhythmic processes that drive the circadian rhythm of myocardial-infarction onset can be identified, their modification may delay or prevent the occurrence of infarction. (N Engl J Med 1985; 313:1315–22.)

Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

2016-10-01

Nicholas J Kassebaum , Megha Arora , Ryan M Barber +7 more

BackgroundHealthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to … BackgroundHealthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development.MethodsWe used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate.FindingsTotal global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9–3·0) for men and 3·5 years (3·4–3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78–0·92) and 1·2 years (1·1–1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs.InterpretationHealth is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum.FundingBill & Melinda Gates Foundation.

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Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015

2017-05-17

Gregory A. Roth , Catherine O. Johnson , Amanuel Alemu Abajobir +7 more

The burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world. The GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality … The burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world. The GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality to produce consistent, up-to-date estimates for cardiovascular burden. CVD mortality was estimated from vital registration and verbal autopsy data. CVD prevalence was estimated using modeling software and data from health surveys, prospective cohorts, health system administrative data, and registries. Years lived with disability (YLD) were estimated by multiplying prevalence by disability weights. Years of life lost (YLL) were estimated by multiplying age-specific CVD deaths by a reference life expectancy. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility. In 2015, there were an estimated 422.7 million cases of CVD (95% uncertainty interval: 415.53 to 427.87 million cases) and 17.92 million CVD deaths (95% uncertainty interval: 17.59 to 18.28 million CVD deaths). Declines in the age-standardized CVD death rate occurred between 1990 and 2015 in all high-income and some middle-income countries. Ischemic heart disease was the leading cause of CVD health lost globally, as well as in each world region, followed by stroke. As SDI increased beyond 0.25, the highest CVD mortality shifted from women to men. CVD mortality decreased sharply for both sexes in countries with an SDI >0.75. CVDs remain a major cause of health loss for all regions of the world. Sociodemographic change over the past 25 years has been associated with dramatic declines in CVD in regions with very high SDI, but only a gradual decrease or no change in most regions. Future updates of the GBD study can be used to guide policymakers who are focused on reducing the overall burden of noncommunicable disease and achieving specific global health targets for CVD.

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Global risk of deadly heat

2017-06-19

Camilo Mora , Bénédicte Dousset , Iain R. Caldwell +7 more

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Estimating economic damage from climate change in the United States

2017-06-30

Solomon Hsiang , Robert E. Kopp , Amir Jina +7 more

Costing out the effects of climate change Episodes of severe weather in the United States, such as the present abundance of rainfall in California, are brandished as tangible evidence of … Costing out the effects of climate change Episodes of severe weather in the United States, such as the present abundance of rainfall in California, are brandished as tangible evidence of the future costs of current climate trends. Hsiang et al. collected national data documenting the responses in six economic sectors to short-term weather fluctuations. These data were integrated with probabilistic distributions from a set of global climate models and used to estimate future costs during the remainder of this century across a range of scenarios (see the Perspective by Pizer). In terms of overall effects on gross domestic product, the authors predict negative impacts in the southern United States and positive impacts in some parts of the Pacific Northwest and New England. Science , this issue p. 1362 ; see also p. 1330

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The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health

2017-10-30

Nick Watts , Markus Amann , Sonja Ayeb‐Karlsson +7 more

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Pollution from Fossil-Fuel Combustion is the Leading Environmental Threat to Global Pediatric Health and Equity: Solutions Exist

2017-12-23

Frederica P. Perera

Fossil-fuel combustion by-products are the world’s most significant threat to children’s health and future and are major contributors to global inequality and environmental injustice. The emissions include a myriad of … Fossil-fuel combustion by-products are the world’s most significant threat to children’s health and future and are major contributors to global inequality and environmental injustice. The emissions include a myriad of toxic air pollutants and carbon dioxide (CO2), which is the most important human-produced climate-altering greenhouse gas. Synergies between air pollution and climate change can magnify the harm to children. Impacts include impairment of cognitive and behavioral development, respiratory illness, and other chronic diseases—all of which may be “seeded“ in utero and affect health and functioning immediately and over the life course. By impairing children’s health, ability to learn, and potential to contribute to society, pollution and climate change cause children to become less resilient and the communities they live in to become less equitable. The developing fetus and young child are disproportionately affected by these exposures because of their immature defense mechanisms and rapid development, especially those in low- and middle-income countries where poverty and lack of resources compound the effects. No country is spared, however: even high-income countries, especially low-income communities and communities of color within them, are experiencing impacts of fossil fuel-related pollution, climate change and resultant widening inequality and environmental injustice. Global pediatric health is at a tipping point, with catastrophic consequences in the absence of bold action. Fortunately, technologies and interventions are at hand to reduce and prevent pollution and climate change, with large economic benefits documented or predicted. All cultures and communities share a concern for the health and well-being of present and future children: this shared value provides a politically powerful lever for action. The purpose of this commentary is to briefly review the data on the health impacts of fossil-fuel pollution, highlighting the neurodevelopmental impacts, and to briefly describe available means to achieve a low-carbon economy, and some examples of interventions that have benefited health and the economy.

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The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report

2019-01-28

Boyd Swinburn , Vivica I. Kraak , Steven Allender +7 more

The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate

2019-11-01

Nick Watts , Markus Amann , Nigel W. Arnell +7 more

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Climate tipping points — too risky to bet against

2019-11-27

Timothy M. Lenton , Johan Rockström , Owen Gaffney +4 more

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Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

2020-10-01

Theo Vos , Stephen S Lim , Cristiana Abbafati +7 more

<h2>Summary</h2><h3>Background</h3> In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level … <h2>Summary</h2><h3>Background</h3> In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. <h3>Methods</h3> GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. <h3>Findings</h3> Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. <h3>Interpretation</h3> As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. <h3>Funding</h3> Bill & Melinda Gates Foundation.

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Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

2020-10-01

Christopher J L Murray , Aleksandr Y. Aravkin , Peng Zheng +7 more

<h2>Summary</h2><h3>Background</h3> Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making … <h2>Summary</h2><h3>Background</h3> Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. <h3>Methods</h3> GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. <h3>Findings</h3> The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. <h3>Interpretation</h3> Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. <h3>Funding</h3> Bill & Melinda Gates Foundation.

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The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises

2020-12-02

Nick Watts , Markus Amann , Nigel W. Arnell +7 more

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Climate Change, Mortality, and Adaptation: Evidence from Annual Fluctuations in Weather in the US

2011-10-01

Olivier Deschênes , Michael Greenstone

Using random year-to-year variation in temperature, we document the relationship between daily temperatures and annual mortality rates and daily temperatures and annual residential energy consumption. Both relationships exhibit nonlinearities, with … Using random year-to-year variation in temperature, we document the relationship between daily temperatures and annual mortality rates and daily temperatures and annual residential energy consumption. Both relationships exhibit nonlinearities, with significant increases at the extremes of the temperature distribution. The application of these results to “business as usual” climate predictions indicates that by the end of the century climate change will lead to increases of 3 percent in the age-adjusted mortality rate and 11 percent in annual residential energy consumption. These estimates likely overstate the long-run costs, because climate change will unfold gradually allowing individuals to engage in a wider set of adaptations. (JEL I12, Q41, Q54)

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Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

2015-09-12

Mohammad H Forouzanfar , Lily Alexander , H Ross Anderson +7 more

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The burden of heat-related mortality attributable to recent human-induced climate change

2021-05-31

Ana M. Vicedo‐Cabrera , Noah Scovronick , Francesco Sera +7 more

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The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future

2021-10-01

Marina Romanello , Alice McGushin , Claudia Di Napoli +7 more

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Survival Analysis

2003-01-01

John P. Klein , Melvin L. Moeschberger

The Environment and Disease: Association or Causation?

1965-05-01

Austin Bradford Hill

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The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels

2022-10-25

Marina Romanello , Claudia Di Napoli , Paul Drummond +7 more

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Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

2024-04-17

Alize J Ferrari , Damian Santomauro , Amirali Aali +7 more

Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden … Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic.

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Biology–society–environment: a changing paradigm for the changing Australian climate

2025-06-25

Arnagretta Hunter | The Medical Journal of Australia

Ambulance Attendance in the State of Queensland, Australia: Exploring the Impacts of Heatwaves Using a Retrospective Population-Based Study

2025-06-25

Jemma C King , Hannah Mason , Amy E. Peden +6 more | Prehospital and Disaster Medicine

Abstract Objective: This study explores the impact of heatwaves on emergency calls for assistance resulting in service attendance in the Australian state of Queensland for the period from January 1, … Abstract Objective: This study explores the impact of heatwaves on emergency calls for assistance resulting in service attendance in the Australian state of Queensland for the period from January 1, 2010 through December 31, 2019. The study uses data from the Queensland Ambulance Service (QAS), a state-wide prehospital health system for emergency health care. Methods: A retrospective case series using de-identified data from QAS explored spatial and demographic characteristics of patients attended by ambulance and the reason for attendance. All individuals for which there was an emergency call to “000” that resulted in ambulance attendance in Queensland across the ten years were captured. Demand for ambulance services during heatwave and non-heatwave periods were compared. Incidence rate ratio (IRR) and 95% confidence intervals (CI) were constructed exploring ambulance usage patterns during heatwaves and by rurality, climate zone, age groups, sex, and reasons for attendance. Results: Compared with non-heatwave days, ambulance attendance across Queensland increased by 9.3% during heatwave days. The impact of heatwaves on ambulance demand differed by climate zone (high humidity summer with warm winter; hot dry summer with warm winter; warm humid summer with mild winter). Attendances related to heat exposure, dehydration, alcohol/drug use, and sepsis increased substantially during heatwaves. Conclusion: Heatwaves are a driver of increased ambulance demand in Queensland. The data raise questions about climatic conditions and heat tolerance, and how future cascading and compounding heat disasters may influence work practices and demands on the ambulance service. Understanding the implications of heatwaves in the prehospital setting is important to inform community, service, and system preparedness.

Assessing the impact of heat waves on childhood immunization coverage in Sindh, Pakistan: Insights from 132.4 million doses recorded in the provincial electronic immunization registry (2018–2024)

2025-06-25

Danya Arif Siddiqi , Sundus Iftikhar , Christian Moretti +7 more | Vaccine

Heat waves, intensified by climate change, are increasingly challenging health systems, particularly in low- and middle-income countries (LMICs). Pakistan, ranked among the top 10 most climate-vulnerable nations, faces significant challenges … Heat waves, intensified by climate change, are increasingly challenging health systems, particularly in low- and middle-income countries (LMICs). Pakistan, ranked among the top 10 most climate-vulnerable nations, faces significant challenges in maintaining routine immunization coverage rates amid soaring temperatures. This study examines the impact of heat waves on immunization delivery in Sindh Province of Pakistan, a region highly vulnerable to climate-induced disruptions. We analyzed child-level data from the provincial electronic immunization registry for 132.4 million immunization doses administered between January 1, 2018, to July 31, 2024. We used the clustered panel univariate and multivariable Poisson and negative binomial regressions to analyze the association between high temperature alert days (33 °C to 39.9 °C) and heat waves (> 40 °C) and immunizations, by vaccination modality (fixed site, routine outreach, enhanced outreach). The analysis controlled for external shocks, such as floods, the COVID-19 pandemic, and vaccinators' strikes, and accounted for geographic and temporal variation. Heat waves and high temperature alert days (≥33 °C) significantly reduced immunizations, with routine and enhanced outreach activities being most affected (13.6 % and 21.2 % decline respectively). Fixed-site immunizations witnessed a comparatively lower decline i.e. 5.8 %. Rural Divisions Larkana and Sukkur were disproportionately affected, while Karachi exhibited minimal impact. Despite the negative impact of heat waves, immunization efforts intensified during external shocks like floods and the COVID-19 pandemic, particularly through prolonged and frequent outreach activities. Heat waves disrupted vaccine service delivery leading to reduced immunization coverage in Sindh, disproportionately affecting immunizations administered through outreach activities. Geographic and temporal variations highlight the need for localized strategies, including improved infrastructure, optimized outreach schedules, and robust vaccine cold chains. Future research should explore long-term adaptive strategies for maintaining vaccination coverage amid increasing impact of climate change, especially in low-resource settings.

Expanding the all-hazards approach to include extreme cold weather: optimising emergency medical care

2025-06-25

Jonathon Lowe , M Warner , K Heil +1 more | BMJ Military Health

Ecology and human health

2025-06-25

А. Е. Северин , Т Е Батоцыренова , L. T. Sushkova | Biomedical Engineering

Exposure to daily mean and maximum 1-hour PM2.5 concentrations and pediatric respiratory mortality in the Mexico City Metropolitan Area

2025-06-25

Iván Gutiérrez‐Avila , Robert O. Wright , María José Rosa +1 more | Environmental Epidemiology

Background: Few studies have evaluated the association between short-term PM 2.5 exposure and children’s respiratory mortality. This study examines the relationship between daily mean and maximum 1-hour PM 2.5 exposures … Background: Few studies have evaluated the association between short-term PM 2.5 exposure and children’s respiratory mortality. This study examines the relationship between daily mean and maximum 1-hour PM 2.5 exposures and age-specific pediatric respiratory mortality, addressing a gap in understanding the effects of subdaily PM 2.5 peaks. Methods: We analyzed ICD-10-coded mortality records (n = 90,566) from the Mexico City Metropolitan Area (2004–2019). PM 2.5 exposures came from our satellite-based models for daily mean and maximum 1-hour concentrations. Using a time-stratified case-crossover design and conditional logistic regression with distributed lags, we examined associations between PM 2.5 and nonaccidental mortality, and specific respiratory conditions (e.g., influenza, pneumonia, bronchopulmonary dysplasia) across neonates, infants, children, and adolescents, accounting for sex-based effect modification. Our models included negative control exposures to address potential confounding. Results: Among all age groups, infants were the most affected by daily mean and maximum 1-hour PM 2.5 concentrations. Mean PM 2.5 was associated with higher risk of respiratory, and influenza and pneumonia mortality in infants. In the same age group, an increase of 10 μg/m 3 in the maximum 1-hour PM 2.5 concentration was associated with nonaccidental (odds ratio [OR][lag 0 ] = 1.02 [95% confidence interval {CI}: 1.00, 1.03]), respiratory (OR[lag 0 ] = 1.04 [95% CI: 1.02, 1.06]), influenza and pneumonia (OR[lag 0 ] = 1.05 [95% CI: 1.02, 1.08]), and bronchopulmonary dysplasia-related (OR[lag 0 ] = 1.07 [95% CI: 1.00, 1.15]) mortality. Our results suggest effect modification by sex in the association between mean PM 2.5 and respiratory mortality, with positive associations observed primarily in male neonates and adolescents. Conclusions: Our study contributes to the evidence on the association between daily PM 2.5 exposure and pediatric respiratory mortality, while also revealing new insights into the impact of maximum 1-hour PM 2.5 on age- and cause-specific respiratory mortality.

Association Between Meteorological Conditions and Acute Myocardial Infarction (AMI) Incidence: A Seasonal Analysis Using the Oita AMI Registry

2025-06-24

Shimato Ono , Hidefumi Akioka , Hiroki Sato +7 more | Cureus

Excellence in a Changing Climate: A Case for Climate-Informed, Environmentally Conscious Physical Therapy Education

2025-06-24

Karin Boos , Noriko Yamaguchi , Cindy Moore +2 more | Journal of Physical Therapy Education

The World Health Organization declared climate change to be "the single biggest health threat facing humanity." Health professionals are called to advocate on behalf of their patients and communities. Physical … The World Health Organization declared climate change to be "the single biggest health threat facing humanity." Health professionals are called to advocate on behalf of their patients and communities. Physical therapy professionals, as health and movement experts, are uniquely qualified to respond to this call. This paper advocates for the integration of climate-informed care, environmental justice, and sustainability into physical therapy education, highlighting its alignment with professional expectations and the evolving needs of society. Climate-informed theory and practice can be integrated into physical therapy education to better address health outcomes and disparities exacerbated by environmental issues. There is support for including this content found within physical therapy professional organization and curricular standard expectations. The frameworks provided by the socio-ecological model and the International Classification of Functioning can be used to integrate climate-informed content across the physical therapy curriculum and clinical practice. Climate-informed and environmental justice content can be integrated into existing science, patient management, and professionalism coursework without curriculum overload. Physical therapy professionals can play a pivotal role in reducing health disparities and climate-related health impacts by practicing climate-informed care, adopting sustainable practices, and advocating for systemic change. This role positions the profession to be a leader+- and aligns with ethical responsibilities. By incorporating climate and environmental justice content, physical therapy education programs ensure that future physical therapy professionals are prepared to address the complex intersection of societal health outcomes and equitable health care.

Climate change and the future of psychiatry: challenges and opportunities for the next three decades

2025-06-24

Júlio Torales , Anthon Daniel Torres-Romero , Marcelo O’Higgins +7 more | International Review of Psychiatry

Association between hypertension and oxidative balance score: data from National Health and Nutrition Examination Survey 2005–2018

2025-06-24

Tao Liao , Yujie Zhou , Lifang Wu +5 more | Frontiers in Cardiovascular Medicine

Background Hypertension, a prevalent worldwide public health issue, can result in a wide range of illnesses. The notably association between oxidative stress and the onset of hypertension has been corroborated … Background Hypertension, a prevalent worldwide public health issue, can result in a wide range of illnesses. The notably association between oxidative stress and the onset of hypertension has been corroborated through diverse animal models. The oxidative balance score (OBS) served as a tool to evaluate the overall systemic status of oxidative stress, indicating that higher OBS scores corresponded to greater exposure to antioxidants. However, the exact correlation between OBS and hypertension is unclear. Therefore, we aimed to investigate whether adult OBS is attached to hypertension. Methods There are 28,035 participants who were chosen from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2018. The presence of hypertension was determined through a questionnaire. Twenty food and lifestyle parameters were used to score OBS. The connection between OBS and hypertension has been examined via weighted logistic regression and smoothing curves. Results The percentage of people with hypertension stood at 41.72%. In comparison to the first quartile of OBS, the adjusted odds ratios for the highest OBS quartile and hypertension were 0.81 (95% CI: 0.70–0.93), with a p -value for trend of 0.002. Age was the factor most strongly linked with both in stratified analysis. Conclusions OBS demonstrated a strong negative association with hypertension, particularly in the younger population (&lt;60 years). These findings highlighted the importance of following an antioxidant-rich diet and lifestyle, which aids in hypertension prevention and appears to offer greater benefits to the younger age group.

Priority Setting in the Context of Planetary Healthcare

2025-06-24

Glory Apantaku , Lydia Kapiriri , Ole Frithjof Norheim +7 more | Applied Health Economics and Health Policy

The realities of ecosystem breakdown and climate change pose a significant threat to the health of individuals around the world, disproportionately affecting poor and vulnerable populations. Every sector in society, … The realities of ecosystem breakdown and climate change pose a significant threat to the health of individuals around the world, disproportionately affecting poor and vulnerable populations. Every sector in society, including healthcare, needs to be engaged in the tremendous collective effort and transformational change needed to limit global warming. We see priority setting as having a key role to play in reallocating existing budgets within healthcare systems whilst at the same time being used to facilitate sustainable and more efficient resource allocation across countries. Priority setting looks to fairly distribute resources with the goal of improving patient and population health outcomes. However, these goals can be broadened to include consideration of environmental impact based on our understanding of the necessity of emissions reduction to address the climate crisis and promote population health. In this paper, we introduce key concepts of priority setting and identify the interplay between priority setting and the realities of resource scarcity in the realm of planetary healthcare. We propose that applying priority-setting principles could serve at least three goals; (1) protect and improve health outcomes; (2) limit unnecessary and marginal care; and (3) facilitate a just transition to a sustainable healthcare system.

The health impact of climate change on the women in reproductive age: a study of coastal communities in Satkhira, Bangladesh

2025-06-24

Md. Noman Amin , Md. Alamgir Hossain , Md. Rakibul Islam +2 more | Frontiers in Public Health

Background Climate change and health issues pose a global threat, particularly in developing countries like Bangladesh. Within the socio-economic structure in coastal regions, women played a crucial role in contributing … Background Climate change and health issues pose a global threat, particularly in developing countries like Bangladesh. Within the socio-economic structure in coastal regions, women played a crucial role in contributing livelihood and living resources, while new climatic ecology creates chaotic relationships between environment and human health. The emerging adverse climatic ecology is directly and indirectly affecting them in the sphere of their both outdoor and indoor activism. This study explores the health impacts of climate change on the women of reproductive age (ages between 14 and 49 from the Bangladeshi perspective) living in coastal communities, i.e., Satkhira, Bangladesh. Methods To choose study locations, this study conducted a literature survey to find out the most vulnerable coastal region of Bangladesh. The study has selected the five most vulnerable unions of Shyamnagar upazila in Satkhira district. This study adopted a multi-method approach combining in-depth interviews and KIIs. Based on this methodological guide, this study interviewed 25 women and 5 married men, while their responses have further been supplemented and validated by KIIs with health workers and medical officers. Results Findings show that climate change posture to new climatic ecology facilitating adverse situations that lead to the intrusion of saline water within communities, lack of fresh and drinkable water, women exposure to waterborne diseases resulting from both salinity and scarcity of fresh usable water, skin disorders, gynaecological and reproductive illnesses, and vector-borne diseases. Women also bear an encountered burden in their struggle to acquire water and good health, including limited hygiene facilities and maternal care. This dilemma is even worsened during the summer season, which exposes women to heat waves, resulting in physical complications such as anaemia, pregnancy risks, heat stroke, dehydration, hypertension and psychological complications like anxiety, stress and depression. Conclusion Breaches in awareness and prevention practices were outlined from the study, as there is a need to realize integrated solutions to address the environmental and health challenges of the populations. Further, there is an absolute need to continue improving access to safe water, healthcare services, and education as a way to build resilience in affected communities.

Sustainability in Oral & Maxillofacial Surgery

2025-06-24

N. Oghabi , C. Fowell , S. Saydzai | International Journal of Oral and Maxillofacial Surgery

Urban Greenery for Health: Mitigating Heat Stress in the UAE Labor Settlements

2025-06-24

Reham A. Abdelwahab , Wael Sheta , Mariam El Hussainy +1 more | Research Square (Research Square)

<title>Abstract</title> This study examines the impact of urban greenery on mitigating heat stress in labor settlements in Dubai, using parametric simulations in the Rhino/Grasshopper framework. The study assesses the impact … <title>Abstract</title> This study examines the impact of urban greenery on mitigating heat stress in labor settlements in Dubai, using parametric simulations in the Rhino/Grasshopper framework. The study assesses the impact of tree shape, park dimensions, and building spacing on the Universal Thermal Climate Index (UTCI) and Mean Radiant Temperature (MRT) through the integration of Ladybug and Honeybee tools. Key findings indicate that tree geometry significantly influences thermal comfort, with elliptical and spherical canopies decreasing UTCI by roughly 3 to 4°C for each 10% increase in canopy density, whereas palm trees have minimal cooling capacity due to their thin foliage and height. Multi-variable optimization determined optimal tree density ranges (5 to 7 trees per 200 m²) and park size ratios (H/W up to 1:5) for optimal cooling effect. The surface temperature predictions were validated using on-site infrared thermography, yielding a root mean square error (RMSE) of 3.72°C for asphalt and 3.34°C for pavement, thereby affirming the dependability of the simulation framework. The findings provide practical recommendations for urban planners and landscape specialists to enhance climate resilience and thermal comfort in labor settlements in Dubai, in accordance with the UN Sustainable Development Goals (SDGs) for climate action and urban sustainability. This study presents an optimization approach that evaluates the crown geometries of tree-native species and improves the predicted accuracy of UTCI mitigation tactics in hot-arid regions using greenery and passive strategies.

Spanish Nurses’ Knowledge and Perceptions of Climate Change: A Qualitative Study

2025-06-24

Antonio Miguel Caraballo-Betancort , Irene Marcilla-Toribio , Blanca Notario‐Pacheco +5 more | Nursing Reports

Background/Objective: Nurses play a critical role in addressing climate change. They are instrumental in both mitigation and adaptation to its effects. Through care provision, education, management, policy development, and research, … Background/Objective: Nurses play a critical role in addressing climate change. They are instrumental in both mitigation and adaptation to its effects. Through care provision, education, management, policy development, and research, nurses can undertake a variety of specific actions in response to climate change. However, their perceptions of this challenge remain under-researched. This study aims to investigate Spanish nurses’ knowledge of climate change and its impact on health. Methods: This is a qualitative descriptive study based on the constructivist paradigm. Purposive and snowball sampling strategies were used to recruit nurses from emergency services, geriatrics, cardiology, respiratory medicine and primary care in nine different regions of Spain. Semi-structured online interviews were conducted. Data analysis was carried out by three researchers via a three-stage inductive thematic analysis approach. Results: The sample consisted of 31 nurses, predominantly women (77.42%), with a mean age of 41 years. Seventy percent of the participants had less than 15 years of experience in the service. Four categories were identified: (i) general knowledge of climate change; (ii) knowledge of climate change and health; (iii) knowledge of actions to address climate change; and (iv) knowledge development. Overall, the nurses demonstrated awareness of the risks posed by climate change as well as actions to respond. However, barriers such as a lack of formal training and eco-anxiety affect their knowledge acquisition. Conclusions: Nurses play an important role in the response to climate change. However, more comprehensive and higher-quality educational programmes, provided by academic institutions, workplaces, and professional associations, are needed. This study was prospectively registered with the Clinical Research Ethics Committee of the Cuenca Health Area on 25 January 2022 (registration number 2021/PI3721).

Perspectives of Korean colorectal surgeons on the climate crisis and sustainability of operating rooms: a cross-sectional study

2025-06-24

Mi Jeong Choi , Heung‐Kwon Oh , Min Hyeong Jo +4 more | Surgical Endoscopy

A comparative analysis of relationships among demographics, political affiliation and ideology, climate change, and health perceptions

2025-06-24

Janice Hawkins , Beth Tremblay , Robert J. Hawkins +1 more | Nursing Outlook

A Rapid Evidence Support System Assessment (RESSA) of health policymaking in Ireland – A Protocol

2025-06-23

Barbara Whelan , Marie Tierney , Nikita N. Burke +7 more | HRB Open Research

<ns3:p>Background Evidence-informed policymaking promotes the use of the best available evidence in a systematic and transparent manner to guide policy decisions. It aims to ensure that policies are grounded in … <ns3:p>Background Evidence-informed policymaking promotes the use of the best available evidence in a systematic and transparent manner to guide policy decisions. It aims to ensure that policies are grounded in credible and relevant evidence while also considering factors such as feasibility, sustainability, equity, and stakeholder input. The Global Evidence Commission has emphasised the necessity for stronger national evidence infrastructures and recommended that governments evaluate their evidence-support systems, focusing on the demand for evidence from policymakers, the supply of timely and relevant evidence, and the coordination between the two. To assist countries in reviewing their evidence-support systems, the Global Commission on Evidence to Address Societal Challenges developed the Rapid Evidence Support System Assessment (RESSA). Here, we outline the protocol for a RESSA of health policymaking being conducted in Ireland. Methods This study will adopt a flexible, mixed-methods design with four key stages: (1) a high-level website review, (2) an in-depth document review, (3) semi-structured interviews with key stakeholders, and (4) seeking feedback. For the document review, the data analysis and synthesis process will follow the READ approach, allowing for a systematic way to organise, interpret, and synthesise the information extracted from the selected documents. Interview data will be analysed using a thematic approach. Findings from both sources will be triangulated to ensure robust conclusions about the strengths and challenges of the evidence-support system for health policymaking. Conclusions This protocol outlines the methods for assessing Ireland’s evidence support system for health policymaking. By documenting our approach in detail, we aim to enhance transparency and replicability, providing a foundation for easier comparison and contrast with similar assessments conducted by other groups. While this study focuses on health, the methodology and findings may also inform evidence-support systems in other sectors, such as climate and education.</ns3:p>

From margins to the centre: Positioning nurses and midwives to create climate-resilient health systems

2025-06-23

Catelyn Richards | Australian journal of advanced nursing

Climate change anxiety and symptom severity in individuals with schizophrenia across seasonal variations: a prospective cohort study

2025-06-23

Shamaz Mohamed , Khaled Elbeh , Naglaa Mohammed +2 more | The Egyptian Journal of Neurology Psychiatry and Neurosurgery

Abstract Background Schizophrenia demonstrates complex interactions with environmental factors, including climate change. This study aimed to investigate the relationship between climate change anxiety and symptoms severity among individual with schizophrenia … Abstract Background Schizophrenia demonstrates complex interactions with environmental factors, including climate change. This study aimed to investigate the relationship between climate change anxiety and symptoms severity among individual with schizophrenia across seasonal variations and it determines. A cohort study was conducted at Assiut University's Psychiatry Hospital, involving 40 individual with schizophrenia and 40 healthy controls. Participants were assessed using multiple tools including the Personality Inventory for DSM-5 (PID-5), Montreal Cognitive Assessment (MOCA), Climate Change Anxiety Scale (CCAS), Symptom Checklist-90-Revised (SCL-90-R), and Positive and Negative Syndrome Scale (PANSS). Data collection spanned a full annual cycle to capture seasonal variations. Results The schizophrenia group showed elevated scores across all personality subscales and lower cognitive function scores than other group. In addition, schizophrenia group exhibited significantly higher climate change anxiety scores compared to controls, with pronounced seasonal variations. Summer presented the highest mean scores for positive symptoms (16.4 ± 5.935), negative symptoms (20.45 ± 5.033), and general psychopathology (39.28 ± 9.597). Medical comorbidity emerged as a significant predictor of climate change anxiety in autumn and winter, while negative symptoms predicted anxiety during winter and spring periods. Conclusions Schizophrenia group experience significant seasonal fluctuations in climate change anxiety, and symptoms, particularly during summer.

Integrating Health and Economic Perspectives: A Comprehensive Review of Dust Mitigation Policies

2025-06-23

Ali Al-Dousari , Hanan Al‐Khalaifah , Salam A. Abbas +7 more | Earth Systems and Environment

Higher in-utero exposure to greenspace can reduce the prevalence of low birth weight in India

2025-06-23

Gautam Kumar Saw , Joe Van Buskirk , Sagnik Dey +1 more | Environmental Research Letters

Abstract An emerging body of evidence suggests that exposure to residential greenspace may provide reproductive health benefits to mothers during pregnancy by promoting physical activity and reducing exposure to environmental … Abstract An emerging body of evidence suggests that exposure to residential greenspace may provide reproductive health benefits to mothers during pregnancy by promoting physical activity and reducing exposure to environmental risks. Here, we addressed this evidence gap in India and assessed the association between residential greenspace and the prevalence of low birth weight (LBW) (birth weight ≤ 2500 g) among Indian mothers. We analyzed health and demographic data from India’s National Family and Health Survey conducted between 2015-16 and 2019-21. Greenspace exposure was quantified using high-resolution MODIS-derived Enhanced Vegetation Index (EVI) data with a 30-day temporal resolution. Multivariable binomial logistic regression models were employed, adjusting for maternal demographics, lifestyle behaviors, socioeconomic status, household characteristics, and exposure to fine particulate matter (PM2.5). Among 38,358 participants, 13,677 (35.6%) had LBW. We found a protective association between EVI and the odds of LBW, with an odds ratio (OR) of 0.99 (95% CI: 0.95 - 1.03) after controlling for covariates. When stratified by PM2.5 exposure levels, the protective effect of EVI was strongest in areas with low PM2.5 concentrations (OR = 0.92; 95% CI: 0.85–1.00), corresponding to an 8% reduction in the odds of LBW. In areas with medium-high exposure, the effect was attenuated (OR = 0.97; 95% CI: 0.90–1.06), while in high exposure areas, the association reversed, with EVI linked to a 23% increase in LBW odds (OR = 1.23; 95% CI: 1.13–1.34). The protective effect was found in urban areas rather than in rural areas and in economically affluent households. Our results suggest that increasing access to greenspace can serve as an adaptive measure to reduce the prevalence of LBW. Further cohort studies are recommended to ascertain the underlying mechanisms.

Pedestrian Mobility Behaviors of Older People in the Face of Heat Waves in Madrid City

2025-06-23

Diego Sánchez González , Joaquín Osorio Arjona | Urban Science

Heat waves affect the health and quality of life of older adults, particularly in urban environments. However, there is limited understanding of how extreme temperatures influence their mobility. This research … Heat waves affect the health and quality of life of older adults, particularly in urban environments. However, there is limited understanding of how extreme temperatures influence their mobility. This research aims to understand the pedestrian mobility patterns of older adults during heat waves in Madrid, analyzing environmental and sociodemographic factors that condition such mobility. Geospatial data from the mobile phones of individuals aged 65 and older were analyzed, along with information on population, housing, urban density, green areas, and facilities during July 2022. Multiple linear regression models and Moran’s I spatial autocorrelation were applied. The results indicate that pedestrian mobility among older adults decreased by 7.3% during the hottest hours, with more pronounced reductions in disadvantaged districts and areas with limited access to urban services. The availability of climate shelters and health centers positively influenced mobility, while areas with a lower coverage of urban services experienced greater declines. At the district level, inequalities in the availability of urban infrastructure may exacerbate the vulnerability of older adults to extreme heat. The findings underscore the need for urban policies that promote equity in access to infrastructure and services that mitigate the effects of extreme heat, especially in disadvantaged areas.

Prevalence of respiratory issues and intervention strategies among different informal sectors in India: A Systematic Review

2025-06-23

D. Chakraborty , Subhashis Sahu | Deleted Journal

The Impact of Temperature, Humidity, and Precipitation on COVID-19 Cases: A Study Across National and Subnational Levels in Pakistan

2025-06-23

Ishtiaq Ahmad , Mustajab Ali , H. M. Noor ul Huda Khan Asghar +6 more | J — Multidisciplinary Scientific Journal

Meteorological variables play a significant role in the transmission of viruses such as influenza and the coronavirus pandemic (COVID-19). Previous studies have identified the relationship between changes in meteorological variables, … Meteorological variables play a significant role in the transmission of viruses such as influenza and the coronavirus pandemic (COVID-19). Previous studies have identified the relationship between changes in meteorological variables, humidity, rainfall, and temperature, and the infection rate of COVID-19 at the national level in Pakistan. However, the current study applied the logistic regression analysis technique to determine such a relationship on a more detailed scale, that is, subnational levels in addition to the national level in Pakistan, using a long-term analysis of two years of COVID-19 data. At the subnational level, the logistic regression analysis technique was applied, with infection rate as the predictive variable. The results showed an increase in the infection rate of COVID-19 with increasing humidity levels. In contrast, an increase in temperature has slowed the spread of COVID-19 cases at both the national and subnational levels. The minimum temperature was statistically significant (p < 0.001) for provinces, KPK and Sindh. Also, two federal territories, AJK and Islamabad, showed statistically significant p-values. At the national level, both maximum temperature and humidity showed such values that is, p < 0.001. We believe that this is the first study conducted in Pakistan to explore the direct and indirect relationship between variables such as temperature (min and max), humidity, and rainfall as predictive parameters for COVID-19 infection rates at a detailed level. The pattern observed in this study can help us predict the future spread of COVID-19, subject to climatic parameters in Pakistan at both the national and subnational levels.

The urgency of the Lancet Planetary Health–Earth Commission’s report and IPBES transformations versus the ongoing Z transformation: the need to soften the human sustainability boundaries

2025-06-21

Filipe Duarte Santos , Timothy O’Riordan , Miguel Rocha de Sousa +1 more | Sustainability Science

Abstract The Lancet Planetary Health–Earth Commission’s report proposes the translation of safe and just Earth-system boundaries across scales, transitions and transformations as being necessary to create a durable pathway to … Abstract The Lancet Planetary Health–Earth Commission’s report proposes the translation of safe and just Earth-system boundaries across scales, transitions and transformations as being necessary to create a durable pathway to sustainability. Here we address the willingness and engagement of individual people to understand, feel the value, and implement the totality of its recommended transformations. We adopt an approach based on inner dimensions of sustainability. This depends on seven human critical determinants that we believe can act as human sustainability boundaries (HSB), but can be suitably softened. We conclude that the required softening of HSBs is unlikely to be successful without phasing down the current counter-sustainability Z transformation. This is an heir of the Neolithic and Industrial Revolutions, but has acquired its own powerful identity, and is apparently unable to deliver sustainability.

Occupational health in the era of climate change and the green transition: a call for research

2025-06-21

Michelle C. Turner , Xavier Basagaña , María Albin +7 more | The Lancet Regional Health - Europe

Acute sodium bicarbonate supplementation reduces the increase in markers of acute kidney injury during physical work in the heat

2025-06-21

Abdulaziz A. Masoud , Zidong Li , Michael R. Deyhle +5 more | European Journal of Applied Physiology

A socioecological approach to understanding and positively affecting the intersectionality between disability, race and ethnicity, climate change, and rehabilitation outcomes: A scoping review

2025-06-21

Prateek Grover , Monica Verduzco‐Gutierrez , Thiru M. Annaswamy | PM&R

Abstract Background Health care outcomes for people with disability may be disproportionately affected by climate change through multiple interlinked factors, which are not well understood. Objective With use of scoping … Abstract Background Health care outcomes for people with disability may be disproportionately affected by climate change through multiple interlinked factors, which are not well understood. Objective With use of scoping review methodology, this study aimed to model this intersectionality using socioecological (SE) levels to connect person‐level rehabilitation diagnoses with systems/policy‐level climate change and use this model to identify multilevel factors, rehabilitation outcomes, and responsive strategies from literature. Methods A scoping review of literature was conducted using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews methodology from three databases (PubMed Medline, Ovid Medline, CINAHL) using combinations of keywords (climate change), (rehabilitation), (disability), and (race). Logic and SE models were combined to model this intersectionality and create review forms that were used to abstract data. Common themes were collated (results), and additional experiential insight was added to provide contextual relevance (discussion). Results Of 32 deduplicated articles, 11 met inclusion criteria for qualitative analysis. Rehabilitation outcomes included physical, economic, mental, cognitive, and mortality (person level); rehabilitation services disruption, medical supply delay, emergency capacity overwhelmed (organizational level); and disabled environment (community level). Responsive strategies included education, backup supplies, planning, social support/utility registration (person level); competency assessment/training, physical medicine and rehabilitation physicians (PM&R) assisting patient in planning, providing pre‐/postevent services, and establishing cross‐coverage (interpersonal level); telerehabilitation, energy/resources conservation, PM&R inclusion in disaster mitigation planning (organization level); building accessible/resilient infrastructure, evidence‐based practice guidelines through professional organizations (community level); and research funding, utility companies prioritizing power, and patients/providers included in planning (system/policy level). Discussion Climate change impact on rehabilitation diagnoses such as spinal cord injury and limb loss, as well as intersectionality with rehabilitation outcomes and identified responsive strategies, has been comprehensively modeled using SE levels. Race is not a commonly identified factor. Conclusion PM&R physicians can play a vital role in this intersectionality of disability, climate change, and rehabilitation outcomes.

The Hidden Burden: Impact of Allostatic Load on Colorectal Cancer Surgery Outcomes

2025-06-21

Mujtaba Khalil , Selamawit Woldesenbet , Zayed Rashid +7 more | Annals of Surgical Oncology

Abstract Background Allostatic load (AL) is a composite measure of the physiological damage caused by socioenvironmental stressors. We sought to investigate the association between AL, social vulnerability index (SVI), and … Abstract Background Allostatic load (AL) is a composite measure of the physiological damage caused by socioenvironmental stressors. We sought to investigate the association between AL, social vulnerability index (SVI), and postoperative outcomes following colorectal cancer (CRC) surgery. Patients and Methods Individuals who underwent surgery for CRC between 2022 and 2024 were identified using the Epic Cosmos database. AL is calculated on the basis of ten biomarkers from four physiological systems (cardiovascular, metabolic, renal, immune). Multivariable regression models were utilized to examine the association between AL and postoperative outcomes. Results Among 40,520 individuals, mean patient age was 67.7 years (SD ±13.9), roughly half of the patients were male ( n = 20,573; 50.8%), and patients generally had a high Charlson comorbidity index score (CCI > 2; n = 33,132; 81.8%). Overall, 7.1% ( n = 2897) of patients had a high AL. Notably, AL increased with increasing SVI (ref: low; medium: 1.10 [95% CI 1.01–1.20]; high: 1.17 [95% CI 1.07–1.28]). High AL was associated with a 48% increased risk of postoperative complications (OR 1.48; 95% CI 1.38–1.58), a 79% increased risk of an extended length of stay (OR 1.79; 95% CI 1.67–1.90), and a twofold (OR 2.13; 95% CI 1.90–2.37) increase in the risk of mortality within 30 days of surgery. Conclusions Individuals with CRC living in socially vulnerable neighborhoods experience high physiological damage and are at a higher risk of postoperative complications and mortality. Therefore, patients from socially vulnerable neighborhoods may require preoperative screening and optimization to mitigate disparities in surgical outcomes.

Assessment of economic loss due to occupational heat stress in Egypt

2025-06-20

Mohamed A. Abdrabo , Mahmoud A. Hassaan | Euro-Mediterranean Journal for Environmental Integration

The Cost of Heat: Health and Economic Burdens in Three Brazilian Cities

2025-06-20

Daniela Debone , Nilton E. Rosário , Simone Georges El Khouri Miraglia | Atmosphere

Excess mortality due to heat is a major public health concern globally. In this study, we investigated the association between extreme heat and mortality in three distinct locations in São … Excess mortality due to heat is a major public health concern globally. In this study, we investigated the association between extreme heat and mortality in three distinct locations in São Paulo state, Brazil—São Paulo city (the capital), Campinas (a large countryside city), and Marília (a typical medium-sized rural city)—from 2004 to 2018. We applied a generalized linear model (GLM) with a Poisson distribution and a logarithmic link function for each city, using the excess heat factor (EHF) as the exposure metric. The results showed that increases in the EHF were associated with relative risks of 1.0018 (95% CI: 1.0015–1.0022) in São Paulo, 1.0029 (95% CI: 1.0023–1.0036) in Campinas, and 1.0033 (95% CI: 1.0025–1.0041) in Marília. Altogether, 2319 heat-attributable deaths were estimated, representing an economic burden of USD 6.03 billion based on the value of a statistical life. By integrating economic valuation with mortality risk estimates, our study offers a broader perspective on the consequences of extreme heat, reinforcing the need for public health and policy interventions.

Climate-Sensitive Health Outcomes in Kenya: A Scoping Review of Environmental Exposures and Health Outcomes Research, 2000–2024

2025-06-20

Jessica Gerard , Titus Kibaara , Iris Martine Blom +7 more | Climate

Climate change threatens health and social development gains in Kenya, necessitating health policy planning for risk reduction and mitigation. To understand the state of knowledge on climate-related health impacts in … Climate change threatens health and social development gains in Kenya, necessitating health policy planning for risk reduction and mitigation. To understand the state of knowledge on climate-related health impacts in Kenya, a scoping review of 25 years of environmental health research was conducted. In compliance with a pre-registered protocol, nine bibliographic databases and grey literature sources were searched for articles published from 2000 to 2024. Of 19,234 articles screened, 816 full texts were reviewed in duplicate, and a final 348 articles underwent data extraction for topic categorisation, trend analysis, and narrative summary. Most of the studies (97%, n = 336) were journal articles, with 64% published after 2014 (n = 224). The health topics centred on vector-borne diseases (45%, n = 165), primarily vector abundance (n = 111) and malaria (n = 67), while mental health (n = 12) and heat exposure (n = 9) studies were less frequent. The research was geographically concentrated on the Lake Victoria Basin, Rift Valley, and Coastal regions, with fewer studies from the northern arid and semi-arid regions. The findings show a shift from a focus on infectious diseases towards broader non-communicable outcomes, as well as regional disparities in research coverage. This review highlights the development of baseline associations between environmental exposures and health outcomes in Kenya, providing a necessary foundation for evidence-informed climate change and health policy. However, challenges in data and study designs limit some of the evidentiary value.

The Critical Role of Environmental Health and Climate Change in Nursing Education Research

2025-06-20

Janice Hawkins | Nursing Education Perspectives

Comment on ‘Diet’s total antioxidant capacity and women’s health: systematic review and meta-analysis’

2025-06-20

Shubham Kumar , Rachana Mehta , Ranjana Sah | British Journal Of Nutrition

Developing a molecular diagnostic model for heatstroke-induced coagulopathy: a proteomics and metabolomics approach

2025-06-20

Qingbo Zeng , Qingwei Lin , Longping He +6 more | Frontiers in Molecular Biosciences

Background Heatstroke (HS) is becoming more concerning, with coagulopathy contributing to higher mortality. The aim of this study was to analyze the metabolomic and proteomic profiles associated with heatstroke-induced coagulopathy … Background Heatstroke (HS) is becoming more concerning, with coagulopathy contributing to higher mortality. The aim of this study was to analyze the metabolomic and proteomic profiles associated with heatstroke-induced coagulopathy (HSIC) and to develop a molecular diagnostic model based on proteomic and metabolomic patterns. Methods This study included 41 HS patients from the Department of Critical Care Medicine at a comprehensive teaching hospital. Plasma proteins and metabolites from HSIC and non-heatstroke-induced coagulopathy (NHSIC) patients were compared using LC-MS/MS. Multivariate and univariate statistical analyses identified differentially expressed proteins (DEPs) and metabolites (DEMs). Functional annotation and pathway enrichment analyses were performed using the GO and KEGG databases, and machine learning models were developed using candidate proteins selected by LASSO and Boruta algorithms to diagnose HSIC. Finally, bioinformatic analysis was used to integrate the results of proteomics and metabolomics to find the potential mechanisms of HSIC. Results A total of 41 patients participated in the study, with 11 cases in the HSIC group and 30 cases in the NHSIC group. Significant differences were observed between the groups in temperature, heart rate, white blood cell count, platelet count, liver function, coagulation markers, APACHE II score, and GCS score. Survival analysis revealed that the heatstroke group had a higher mortality risk. A total of 125 DEPs and 110 DEMs were identified, primarily enriched in energy regulation-related pathways and lipid and carbohydrate metabolism. Additionally, three optimal predictive models (AUC &gt;0.9) were developed and validated for classifying HSIC from HS individuals based on proteomic patterns and machine learning, with the logistic regression model showing the best diagnostic performance (AUC = 0.979, sensitivity = 81.8%, specificity = 96.7%), highlighting lactate dehydrogenase A chain (LDHA), neutrophil gelatinase-associated lipocalin (NGAL), prothrombin and glucan-branching enzyme (GBE) as key predictors of HSIC. Conclusion The study uncovered critical metabolic and protein changes linked to heatstroke, highlighting the involvement of energy regulation, lipid metabolism, and carbohydrate metabolism. Building on these findings, an optimal machine learning diagnostic model was developed to boost the accuracy of HSIC diagnosis, integrating LDHA, NGAL, prothrombin, and GBE as key biomarkers.

Kindertageseinrichtungen in der Klimakrise

2025-06-20

Silvia Wiedebusch | Frühe Bildung

Exposing Inequality

2025-06-20

Ritu Thamman , Samar A. Nasser , Keith C. Ferdinand +2 more | JACC Advances

Regional variations in the impacts of high temperature on hospital admissions in Brazil

2025-06-20

Huiqi Chen , Ivan Augusto Cecilio e Silva , Shakoor Hajat +7 more | Environment International

High temperatures driven by climate change significantly threaten global health. Their impact on health systems, particularly within low- and middle-income countries, remains underexplored. Daily non-elective hospital admissions were collected from … High temperatures driven by climate change significantly threaten global health. Their impact on health systems, particularly within low- and middle-income countries, remains underexplored. Daily non-elective hospital admissions were collected from the Brazil Hospital Information System for 5,459 (98%) Brazilian municipalities, 2008-2019. Gridded daily maximum temperatures were obtained from the European Centre for Medium-Range Weather Forecasts Reanalysis V5 for the historical period (2008-2023) and projected up to 2060 under three SSP emission scenarios. Population projections were derived from WorldPop. We used a case time-series design and distributed lag non-linear models to examine the relationship between temperature and hospitalisation risk for each state, estimating the number of heat-attributable hospitalisations from 2008 to 2060. Related economic costs were estimated using a cost-of-illness approach including direct and indirect costs. Without adaptation, high-temperature-related annual hospitalisations were projected to reach 51 (95 % CI: 19-103), 54 (21-106), and 59 (25-112) per 100,000 population in the 2050s under SSP1-2.6, SSP2-4.5, and SSP5-8.5 scenarios, respectively, representing 54 %, 62 %, and 78 % increases from the 2010s baseline of 33 (9-67) per 100,000. Annual economic costs were projected to reach $228-$264 million in the 2050s, with higher absolute costs in the South and faster relative increases in the North. The substantial impact of heat on hospitalisations, and its associated costs to the health sector and wider economy, worsen under future climate and demographic change. Regional adaptation and targeted healthcare investments are crucial to manage rising health burdens. UK Research and Innovation; China Scholarship Council.

Heatwave-Induced Thermoregulatory Stress in Odisha's Coastal and North-Eastern Districts: Examining the April 2024 Event Using Advanced Statistical and Geospatial Techniques

2025-06-20

Roshan Beuria , Dipak K. Sahu , Sarat Chandra Sahu +4 more | Dynamics of Atmospheres and Oceans

Efeitos das ondas de calor e mortalidade por doenças cardiovasculares nas capitais brasileiras

2025-06-20

Franciely Maria Carrijo Campos , Washington Leite Junger | Contribuciones a las Ciencias Sociales

As ondas de calor têm sido associadas a morbimortalidade por doenças do aparelho circulatório em diferentes locais, principalmente em ambientes urbanos, afetando os grupos considerados vulneráveis. O objetivo deste estudo … As ondas de calor têm sido associadas a morbimortalidade por doenças do aparelho circulatório em diferentes locais, principalmente em ambientes urbanos, afetando os grupos considerados vulneráveis. O objetivo deste estudo foi estimar os efeitos de ondas de calor na mortalidade por doenças do aparelho cardiovascular nas capitais brasileiras, além disso, foi investigada a modificação de efeito segundo a intensidade e duração das ondas de calor. A análise de séries temporais foi utilizada para estimar o percentual do Risco Relativo (%RR) do efeito das ondas de calor na mortalidade de pessoas adultas ≥ 30 anos de idade, durante o periodo do de 2000 a 2016. Os resultados indicaram uma associação entre ondas de calor e a mortalidade por doenças cerebrovasculares e doenças isquêmicas do coração na população adulta. Houve ocorrência de onda de calor no inverno. O efeito sem adição tem maior %RR e aumenta proporcionalmente ao critério de intensidade dos percentis.

Exploring eco-anxiety among women amid climate-induced heat: a comprehensive review

2025-06-19

Gayathri K. G , Vijayalakshmi Poreddi , Krishnan Srinivasan +3 more | Frontiers in Psychology

Eco-anxiety, the chronic fear of environmental doom, has become more frequent as climate change accelerates, particularly among disadvantaged population. This comprehensive review explores the relationship between eco-anxiety and gender differences, … Eco-anxiety, the chronic fear of environmental doom, has become more frequent as climate change accelerates, particularly among disadvantaged population. This comprehensive review explores the relationship between eco-anxiety and gender differences, with a particular emphasis on women who experience stress and summarises the existing literature on the psychological and emotional responses to heat-related climate stressors. The current review critically examined a total of 21 articles and synthesised the scholarly literature on eco-anxiety, then it was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR). Women often face socioeconomic and physiological challenges, leading them to be more vulnerable to the effects of climate change, such as extreme heat events. This review was mainly focussed on the climate induced pathways to psychological consequences and gender differences with respect to eco-anxiety which strives to reveal targeted support systems and promote more inclusive climate resilience planning by comprehending the gender-specific dimensions of eco-anxiety. We observed that most of the evidence were from Western countries, hence global research is essential. According to our review, further study is needed to define eco-anxiety with respect to climate induced heat.

Environmental History of Disease, Health, and Medicine

2025-06-19

Kristin Brig-Ortiz | Environmental History

Climate change and COVID-19 may serve as recent reminders of the relationship between health and the environment, but the connection is by no means new. While historical scholarship on the … Climate change and COVID-19 may serve as recent reminders of the relationship between health and the environment, but the connection is by no means new. While historical scholarship on the relationship between environment and health is still emerging, it has clearly shown that at no point in history have humans ever wholly extracted themselves from nature or their environments, because humans exist in a myriad of local and global ecologies, in which they become entangled with their surroundings. As a result, human and nonhuman health are bound up with and often dependent on one another. Beginning with colonization efforts in the early modern period, society on a global scale has grown through adaptation to and extraction of the environment, with significant health effects for humans, animals, plants, fungi, and other environmental elements. This growth in particular has centered on three important developments in human–environment relations: first, the incidence of disease and its connection with environmentally extractive processes; second, the use of local knowledge and natural materials to address these diseases, among other health issues; and third, the international push for all communities to have access to cleaner water, air, and spaces.

Direct and indirect influences of the environment on cardiovascular disease.

2021-12-01

Alberto García‐Lledó , Elvira García‐de‐Santiago