Health Implications of Climate Change: a Review of the Literature About the Perception of the Public and Health Professionals

Health professionals' perceptions of climate change: A systematic review of qualitative studies

OBJECTIVE

To understand health professionals' perceptions of climate change and its impact on health and their perceived role.

STUDY DESIGN

This was a systematic review of qualitative studies.

METHODS

A systematic review of qualitative evidence from three databases (MEDLINE, CINHAL and PsycInfo) was conducted according to the Cochrane method in June 2024. The PRISMA 2020 guidelines were followed for the synthesis report.

RESULTS

A total of 215 results were obtained, of which 10 studies were included on the basis of the inclusion criteria. The selected studies included predominantly nurses, physicians and public health professionals, with a smaller representation of other allied health professionals from Europe, North America and Africa. These studies were published between 2015 and 2024. Three themes were identified: "general knowledge of climate change", "role of health professionals in addressing climate change" and "barriers to action on climate change". Health professionals are aware of the health risks posed by climate change, but some barriers prevent or hinder their action. The main barriers are poor, overly generalised information and training, and a demotivating environment.

CONCLUSION

Health professionals are aware of the existence and dangers of climate change but are less aware of their role in the face of climate change. Contextualised training and an enabling environment are needed. It is essential to study the perceptions of each group of health professionals at the national or subnational level.

Perceptions of medical and public health professionals on climate change and emerging health challenges in Pakistan: a multi-scale approach

BACKGROUND AND OBJECTIVES

Climate change is a significant global health threat, disproportionately impacting low- and middle-income countries. Urban centres like Karachi, Pakistan, face rising incidences of vector-borne and waterborne diseases because of changing climate (CC). This study aimed to explore the perceptions of healthcare professionals regarding climate change, its health impacts, and their role in addressing these challenges.

METHODS

A qualitative study was conducted using nine focus group discussions with 46 healthcare professionals, including doctors, nurses, and public health experts from three major hospitals and two postgraduate institutions in Karachi. Participants were recruited through snowball sampling, and data were collected using semi-structured interviews. Thematic analysis was conducted to identify both manifest and latent themes in the data.

RESULTS

The analysis revealed seven major themes: awareness of climate change, health impacts, economic and social consequences, environmental and natural disasters, the role of healthcare professionals, mitigation strategies, and policy challenges. Participants demonstrated varied levels of awareness, influenced by their educational background and professional specialization, with public health professionals exhibiting a broader understanding compared to other healthcare workers. Key concerns included the rise of infectious diseases, food insecurity, and urban resource strain. Participants identified barriers such as inadequate training, limited resources, and weak policy enforcement that hinder their ability to address climate impacts effectively.

CONCLUSIONS

Healthcare professionals in Karachi play a critical role in mitigating climate-related health impacts. Enhanced education, integration of climate change into medical curricula, and interdisciplinary collaboration are essential. Strengthened policies and systemic investments are needed to empower healthcare workers as leaders in climate adaptation and mitigation efforts.

Engaging health professionals in climate change: a cross-national study of psychological distance across 12 countries

BACKGROUND

Understanding the psychological distance (PD) of health professionals toward climate change is essential to promote effective climate action and informed health policy. While climate change poses a global health threat requiring urgent collaboration, limited cross-national research exists on health professionals' perspectives, particularly on how they perceive PD in relation to climate change.

OBJECTIVE

This study aims to provide initial insights into how health professionals perceive climate change across different countries, focusing on key factors influencing PD, including personal experiences, uncertainty, perceptions, information environments, global interconnectedness, and climate-resilient infrastructure.

METHODS

This research employed an exploratory mixed-methods approach, combining descriptive surveys and in-depth semi-structured interviews with 18 early-to-mid-career health professionals from 12 countries. This design facilitated a nuanced exploration of the dimensions of PD-temporal, spatial, social, and uncertainty-related-by integrating quantitative data with qualitative insights to uncover emerging trends and hypotheses.

RESULTS

Findings reveal diverse perceptions of PD among health professionals, shaped by contextual factors such as exposure to extreme weather, information environments, and infrastructure development. These results challenge the oversimplified view that professionals in developing countries consistently perceive climate change impacts as more distant, underscoring the need for localized understandings of PD.

CONCLUSION

Assessing PD requires consideration of its diverse dimensions to inform effective climate-related behaviors and interventions. Tailored communication strategies reflecting unique national and regional contexts are essential to engage health professionals, enabling them to drive climate discourse and policy advocacy. This study highlights the potential of the early-to-mid-career health professionals in bridging the gap between public awareness and climate action. Their unique position enables them to drive long-term climate adaptation and policy implementation, fostering both global and localized solutions to climate challenges.

Infectious Disease Specialists' awareness, perceptions and attitudes toward ecological transition in healthcare: a cross-sectional study in France

INTRODUCTION

Climate change is having a major impact on public health. The healthcare system is responsible for around 8% of greenhouse gas emissions in France. Infectious diseases (ID) lie at the heart of these consequences.

OBJECTIVES

The primary aim of this study was to assess the expectations of French ID specialists in terms of a sustainable healthcare transition. Secondary objectives included the assessment of awareness regarding this subject, perceptions, adopted attitudes and opportunities for actions.

METHODS

A survey on sustainable healthcare transition was sent to all the French Society for ID members.

RESULTS

Of the 860 physicians approached, 220 responded. More than 78% of respondents responded correctly to questions concerning the impact of climate change on public health. The environmental impact of the healthcare system was less well understood. A higher level of environmental anxiety was associated with a higher rate of declaration of concrete actions. People under 40 years of age declared themselves to be more active. Regarding attitudes towards the roles of different stakeholders in a sustainable healthcare transition, the role of medical societies is prominent. Respondents' main expectations and suggestions are the following: (1) creation of a cross functional group dedicated to a sustainable healthcare transition, (2) creation of a training program, to meet the training needs of 94% of respondents, (3) continuation of the French Society for ID's lobbying for the relocation of antibiotic production in Europe, research on life-cycle analysis of anti-infective drugs, single-dose packaging for antibiotics, (4) reflection on the concept of "sustainably designed healthcare" in ID, (5) continued exploration of the "One Health" concept and (6) development of recommendations for sustainably designed hygiene practice.

CONCLUSION

This national survey of French ID specialists is a prerequisite for the implementation of actions within the French Society for ID.

Assessing the role of education level on climate change belief, concern and action: a multinational survey of healthcare professionals in nephrology

BACKGROUND

Climate change poses a significant risk to kidney health, and countries with lower national wealth are more vulnerable. Yet, citizens from lower-income countries demonstrate less concern for climate change than those from higher-income countries. Education is a key covariate. To examine its role in explaining this perception gap, we obtained the perspectives of a highly educated cohort of healthcare professionals.

METHODS

This was a cross-sectional survey of healthcare professionals involved in kidney care. Responses were compared by the income level of the participant's country (per World Bank).

RESULTS

Of the 849 healthcare professionals from 107 countries (63.4% from lower and middle-income countries) that participated, most believed climate change was happening (97.9%), displayed a high level of concern (73.3%), and took personal action to combat climate change (62.0%). While the proportion who believed in climate change did not vary by income level (high:98.1%, upper-middle:97.2%, lower-middle:97.8%, low:100%, p = 0.73), the proportion with a higher level of concern (high:80.7%, upper-middle:74.9%, lower-middle:67.5%, low:53.8%, p < 0.001), and who took climate action (high:76.2%, upper-middle:63.1%, lower-middle:51.2%, low:30.8%, p < 0.001) decreased by national wealth. Barriers to involvement in sustainable kidney care were lack of time (54.4%), knowledge (39.7%), and peer support (30.3%). Only 34.0% were aware of national mitigation plans and barriers related to finances, technologies, tools, methods, research, and evidence were perceived as greater obstacles in lower-income countries.

CONCLUSIONS

Our results highlight that predictors and correlates of climate change risk perception vary across countries. Education alone is unlikely to increase individual and group engagement in climate change. A better understanding of these factors can inform strategies towards climate action in different settings.

Association between climate change and patient health outcomes: a mixed-methods systematic review

INTRODUCTION

Climate change poses significant threats to the environment, biodiversity, and socioeconomic stability worldwide. Its impact on human health, particularly within healthcare systems, is growing in concern. Nurses, as front-line healthcare workers, play a crucial role in addressing climate-related health risks. However, there is a gap in understanding nursing perspectives on climate change and its implications for patient health outcomes.

AIM

To synthesize empirical evidence on the association between climate change and patient health outcomes from a nursing perspective.

METHODS

A mixed-methods systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was carried out in January 2024 in six scientific databases including CINAHL, PubMed, Scopus, ProQuest, Web of Science, and OVID Nursing. Studies focusing on climate change and patient health outcomes from a nursing perspective were included. Data extraction, quality appraisal, and synthesis were performed systematically.

RESULTS

The systematic review included 18 studies of a mainly quantitative nature. Three main themes emerged as follows: Climate Healthcare Interplay; Future Nurses as Agents of Change; and Navigating Sustainability Challenges in Nursing. These themes highlighted nurses' awareness of the interrelation between climate and health, the need for environmental education in nursing, and the challenges that hinder sustainable nursing practices.

CONCLUSION

This review underscores the importance of integrating climate change topics into nursing education and fostering organizational support for sustainable nursing practices. Addressing these challenges is essential for nurses to mitigate the health risks posed by climate change effectively.

"We are not ready for this": physicians' perceptions on climate change information and adaptation strategies - qualitative study in Portugal

Background

Climate change presents several challenges to public health and its professionals. This article aims to fill a significant gap in the current literature by understanding physicians' perceptions of their role in educating others about health adaptation to climate change. It also explores their knowledge of health policies related to this issue in Portugal and their perceived influence on the development of adaptation policies at both local and national levels within the health sector.

Methods

To this end, we applied a qualitative and case study approach, interviewing 13 physicians in Portugal, including general practitioners and specialists. The data was collected using a semi-structured interview script, and a content analysis was performed to categorize the responses and gain a comprehensive understanding of the phenomenon.

Results

The main results of this study highlight the need for a more systematic approach to training physicians, including the relationship between climate change and health. Concerning policies, this research highlights the need for more consistent communication and precise guidelines for dealing with the impacts of climate change on public health.

Conclusion

As the first exploratory study focusing on Portuguese physicians, this research provides unique insights into their views on the potential to influence patient behavior and health policy. Importantly, it offers valuable recommendations for health policy strategies, particularly in awareness-raising and training plans for these professionals, thereby demonstrating the research's practical implications.

Caregivers of children with asthma alarmed by climate change: a cross-sectional study

BACKGROUND

Climate change poses significant health risks, with children being particularly vulnerable to its adverse health effects. Children with asthma are expected to have worsening disease due to increased exposure to heat, air pollution, mold from flooding, and pollen. Understanding caregiver perspectives on these health harms is crucial for informing public health policy and education. Therefore, we aimed to explore caregiver perceptions of climate change-related health risks to children with asthma.

METHODS

In this cross-sectional study, a survey instrument was created and distributed to caregivers of children with asthma during their visits to pulmonology clinics located in an urban northeastern US setting and via email.

RESULTS

Among 198 completed surveys, 78% of participants reported high levels of concern about climate change, with most respondents agreeing that climate change has already impacted their child's health. Examples provided by respondents included worsening asthma control due to air pollution, wildfire events, pollen exposure, and rapid changes in weather. Respondents who self-identified as female had greater concern. Most respondents agreed that these topics should be further discussed with their child's doctor. Although, barriers to such discussions were noted by the respondents.

CONCLUSION

Caregivers of children with asthma have high levels of concern regarding climate change and report adverse impacts on their child's asthma. Clinicians caring for children with asthma should consider discussing the respiratory health impacts of climate change with caregivers. However, barriers to these discussions need further examination.

Patient safety and climate change: findings from a cross-sectional survey in Germany

BACKGROUND

Patient safety has become a priority issue in health policy strategies in Germany in the last several years, and is especially important in the era of climate change. This study aimed to assess public perceptions about the patient safety impact of climate change and the demographic and socioeconomic factors influencing patient perception in Germany.

METHODS

A cross-sectional study was conducted in Germany in 2023, using data from the TK Monitor of Patient Safety. The TK Monitor of Patient Safety is a national survey of the population on the state of safety in medical care. Self-reported data were collected from 1,000 randomly selected adults living in Germany. Demographic and socioeconomic variables were regressed on climate change perception using an ordinal logistic regression approach.

RESULTS

Our results revealed that half of respondents are concerned about climate change affecting their health and 40% of the respondents would like to have climate-sensitive health counseling by their general practitioner. The results showed that demographic variables, such as gender and age, and socioeconomic variables, such as education level and income, are important factors influencing the perception of climate change-related patient safety risks. However, no association was found between urban/rural residence and patient perception.

CONCLUSIONS

Our study highlights patient safety as a public health concern in the era of climate change. The German public appears to view climate change as harmful to patient safety. Our findings also show that it is necessary to carry out diagnoses focused on demographic and socioeconomic factors to determine which aspects should be strengthened through programs aimed at reducing patient safety risks associated with climate change.

A review of climate change and cardiovascular diseases in the Indian policy context

There is growing evidence that climate change adversely affects human health. Multiple diseases are sensitive to climate change, including cardiovascular diseases (CVDs), which are also the leading cause of death globally. Countries such as India face a compounded challenge, with a growing burden of CVDs and a high vulnerability to climate change, requiring a co-ordinated, multi-sectoral response. In this framework synthesis, we analysed whether and how CVDs are addressed with respect to climate change in the Indian policy space. We identified 10 relevant national-level policies, which were analysed using the framework method. Our analytical framework consisted of four themes: (1) political commitment; (2) health information systems; (3) capacity building; and (4) cross-sectoral actions. Additionally, we analysed a subset of these policies and 29 state-level climate change and health action plans using content analysis to identify health priorities. Our analyses revealed a political commitment in addressing the health impacts of climate change; however, CVDs were poorly contextualized with most of the efforts focusing on vector-borne and other communicable diseases, despite their recognized burden. Heat-related illnesses and cardiopulmonary diseases were also focused on but failed to encompass the most climate-sensitive aspects. CVDs are insufficiently addressed in the existing surveillance systems, despite being mentioned in several policies and interventions, including emergency preparedness in hospitals and cross-sectoral actions. CVDs are mentioned as a separate section in only a small number of state-level plans, several of which need an impetus to complete and include CVD-specific sections. We also found several climate-health policies for specific diseases, albeit not for CVDs. This study identified important gaps in India's disease-specific climate change response and might aid policymakers in strengthening future versions of these policies and boost research and context-specific interventions on climate change and CVDs.

Climate Change and Environmentally Sustainable Kidney Care in Canada: A Knowledge, Attitudes, and Practices Survey of Kidney Care Providers

Background

Climate change impacts health and threatens the stability of care delivery systems, while healthcare is mobilizing to reduce its significant environmental impact.

Objective

This study aimed to assess knowledge, attitudes, and practices (KAP) about climate change among Canadian kidney care providers.

Design setting participants measurements and methods

An electronic KAP survey, created by the Canadian Society of Nephrology-Sustainable Nephrology Action Planning committee, was distributed to kidney care providers across Canada, from March to April 2023.

Results

A total of 516 people responded to the survey. Most respondents (79%) identified as women; 83% were aged 30 to 59 years. Nurses and nephrologists made up 44% and 23% of respondents, respectively. About half of the participants felt informed about climate change to an average degree. Most respondents (71%; 349/495 and 62%; 300/489) were either extremely or very concerned about climate change and waste generated in their kidney care program, respectively. The vast majority of respondents (89%; 441/495) reported taking steps to lower their personal carbon footprint. People who felt more informed about climate change presented higher degrees of concern. Similarly, both those who felt more informed and those who reported higher degrees of concern about climate change were more likely to take steps to reduce their carbon footprint. Over 80% of respondents (314/386) were at least moderately interested in learning sessions about environmentally sustainable initiatives in care.

Limitations

This survey is at risk of social acceptability, representative, and subjective bias. Overrepresentation from Quebec and British Columbia, as well as the majority of respondents identifying as women and working in academic centers, may affect generalizability of the findings.

Conclusions

Most kidney care providers who responded to this survey are informed and concerned about climate change, and their knowledge is directly associated with attitude and practices. This indicates that educational initiatives to increase awareness and knowledge on climate change will likely lead to practice changes.

Risk perceptions of Italian paediatricians for the impact of climate change on children's health

BACKGROUNDS

This study delves into the risk perceptions of Italian pediatricians concerning climate change's impact on children's health. Given children's heightened vulnerability to climate-related health risks, comprehending these perceptions is crucial. A review of pertinent literature establishes the framework, emphasizing six key factors influencing children's susceptibility to climate-related health hazards.

METHODS

Methodologically, the study utilized a survey tool developed collaboratively with the Italian Society of Pediatrics (SIP), garnering responses from a representative sample of Italian pediatricians.

RESULTS

Findings indicate a high level of awareness among respondents regarding climate change and its health implications, with a majority attributing it primarily to human activity. Pediatricians recognize various current and anticipated health impacts of climate change, notably concerning illnesses linked to outdoor air quality. Despite acknowledging their role in addressing climate-related health concerns, respondents also cite barriers to engagement, including time constraints and knowledge gaps. However, they express interest in resources like professional training and policy statements to bolster their capacity for effective communication and advocacy.

CONCLUSIONS

Comparisons with prior studies highlight the consistency of findings across diverse contexts and underscore the significance of integrating climate and environmental health education into medical training. Overall, this study sheds light on pediatricians' perspectives in tackling the convergence of climate change and children's health, pinpointing avenues for enhancing their involvement in climate advocacy and mitigation efforts.

Pan American climate resilient health systems: a training course for health professionals

Objectives

To describe the development, implementation, and results of a training course designed to equip health professionals from the Pan American Health Organization region with the knowledge and tools needed to adapt health systems to current climate realities.

Methods

The Pan American climate resilient health systems course was a 9-week live-virtual course in March-April 2023, which was delivered through Zoom and offered in English, Spanish, and French. All lectures were delivered by local and regional climate and health experts. The curricular foundation of this initiative was the Global Consortium on Climate and Health Education core competencies for health professionals. Participants completed pre- and post-course surveys.

Results

A total of 1212 participants attended at least one of the nine sessions and 489 (from 66 countries) attended at least six sessions. Of these, 291 participants completed both the pre- and post-course surveys which were used in the analysis. Longitudinal survey results suggested an improvement in participants' climate and health communication, an increased frequency of incorporating climate knowledge in professional practice, and improved confidence in engaging in climate initiatives. At the same time, many participants expressed a need for additional training.

Conclusions

The results indicate that live-virtual courses have the potential to empower health professionals to contribute to climate resilience efforts by: increasing their communication skills; changing their professional practice; increasing their ability to lead climate and health activities; and preparing them to assess vulnerability and adaptation in health systems, measure and monitor environmental sustainability, and apply a health equity lens.

Anaesthesia and climate change: time to wake up? A rapid qualitative appraisal exploring the views of anaesthetic practitioners regarding the transition to TIVA and the reduction of desflurane

BACKGROUND

The National Health Service (NHS) has pledged to reach carbon net-zero by 2040. In alignment with this goal, a London hospital's anaesthesia department is actively reducing desflurane use and transitioning towards total intravenous anaesthesia (TIVA) as a sustainable alternative, contributing to environmentally responsible practices within the healthcare sector.

METHODS

We conducted a rapid qualitative appraisal through online interviews with 17 anaesthetic practitioners to explore their perspectives regarding this climate change mitigation strategy. Data analysis was undertaken through the use of rapid appraisal sheets and a framework analysis method.

RESULTS

Participants highlighted the disadvantages of TIVA, including the increased effort, heightened monitoring requirements, operational challenges, and a lack of clinical confidence associated with its use. Despite these reservations, participants acknowledged TIVA's potential to reduce postoperative nausea. There were perceptions that senior staff members might resist this change due to habits and scepticism over its impact on climate change. To facilitate greater TIVA adoption, participants recommended enhanced training, the implementation of a dashboard to raise awareness of greenhouse gas (GHG) emissions, and the presence of strong climate change leadership within the department. Participants believed that a shift to TIVA should be followed by specific measures such as addressing waste management which is crucial for GHG reduction, emphasising the perceived link between waste and emissions.

CONCLUSIONS

The evaluation examines stakeholder attitudes, perceptions, and behaviours, focusing on transitioning from desflurane to TIVA. The study highlights the importance of staff engagement, organisational support, and underscores the crucial role that healthcare practitioners and leadership play in fostering sustainability within the healthcare sector.

Climate change and its impact on health: a global collaborative learning model

To address the health effects of climate change, leaders in healthcare have called for action to integrate climate adaptation and mitigation into training programs for health professionals. However, current educators may not possess sufficient climate literacy and the expertise to effectively include such content in their respective healthcare curricula. We, an international and interprofessional partnership, collaborated with experts to develop and deploy curriculum to increase health educators' and graduate health profession students' knowledge and competencies on climate change. In a tri-step process, the first phase included recruiting interested faculty members from two institutions and varying health professions. In phase two, faculty members collaborated to develop a faculty symposium on climate change including educational competencies required of health professions, practice standards, guidelines, and profession-specific content. Symposium outcomes included broader faculty member interest and commitment to create an interprofessional climate change course for healthcare graduate students. In phase three, course development resulted from collaboration between faculty members at the two institutions and faculty members from the Global Consortium on Climate and Health Education (GCCHE), with course objectives informed by GCCHE competencies. Climate experts and faculty members delivered the course content over a 10-week period to 30 faculty members and students representing seven health professions, who were surveyed (n = 13) for feedback. This course can serve as an example for international collaborators interested in developing climate change courses for health profession students. Lessons learned in this process include: climate change novice faculty members can develop impactful climate change courses; students and faculty members can be co-learners; diverse representation in course attendees enriches the learning experience; and collaboration is key.

Essential competencies of nurses for climate change response in Saudi Arabia: A rapid literature review

AIM

Amidst the mounting challenges posed by climate change, the healthcare sector emerges as a vital frontliner, with nurses standing as its linchpins. This review delves into the pivotal role of nurses in combatting the health consequences of climatic alterations, particularly within the nuanced environment of Saudi Arabia.

DESIGN

A rapid literature review.

METHOD

Drawing from a rigorous analysis of 53 studies, our exploration revolves around the preparedness strategies formulated in response to Saudi Arabia's changing climate. The variables analysed included study design, sample size, focus area, geographical coverage and key findings related to nurse competencies. Data were collected using a structured data extraction form and analysed using thematic content analysis. Employing content analysis, we discerned essential domains: from grasping the health impacts of climate change to customizing care for the most susceptible populations and championing advocacy initiatives.

FINDINGS

Salient findings highlight nurses' profound understanding of both direct and secondary health implications of climate shifts. Additionally, the results emphasize the tailored interventions needed for vulnerable groups, capacity building and disaster readiness. Crucially, our findings spotlight the significance of weaving cultural, ethical and regional threads into nursing strategies. By painting a comprehensive picture, we showcase the delicate balance of environmental evolution, healthcare dynamics and the unique socio-cultural tapestry of Saudi Arabia.

CONCLUSION

The results of our analysis revealed key competencies required for nurses, including the ability to address immediate health impacts, provide tailored care for vulnerable populations and engage in advocacy and policy formulation. In summation, nurses' multifaceted roles-from immediate medical care to research, advocacy and strategizing-underscore their invaluable contribution to confronting the health adversities sparked by climate change. Our review accentuates the essential contributions of nurses in tackling climate-related health hurdles and calls for more nuanced research, policy adjustments and proactive measures attuned to Saudi Arabia's distinct backdrop.

Climate Change, Kidney Health, and Environmentally Sustainable Kidney Care: A Multinational Survey of Health Care Professionals

Key Points

Background

Given the threat of climate change to kidney health and the significant environmental effect of kidney care, calls are increasing for health care professionals and organizations to champion climate advocacy and environmentally sustainable kidney care. Yet, little is known about their engagement, and existing literature is primarily emerging from high-income countries.

Methods

We conducted a cross-sectional survey to understand the knowledge, attitude, and practice of health care professionals on the interconnectedness of climate change and kidney health; to identify personal and organizational initiatives in sustainable kidney care and strategies to increase their engagement; and to compare responses by their country's income level as classified by the World Bank.

Results

Participants (n=972) represented 108 countries, with 64% from lower- or middle-income countries. Ninety-eight percent believed that climate change is happening, yet <50% possessed knowledge about the effect of climate change on kidney health or the environmental effect of kidney care. Only 14% were involved in climate change and kidney health initiatives (membership, knowledge/awareness, research, and advocacy), 22% in sustainable kidney care initiatives (education/advocacy, preventative nephrology, sustainable dialysis, promoting transplant/home therapies, and research), and 26% reported organizational initiatives in sustainable kidney care (sustainable general or dialysis practices, preventative/lean nephrology, and focused committees). Participants from lower-income countries generally reported higher knowledge and variable level of concern. Engagement in sustainable kidney care did not vary by income level. Guidance/toolkit (79%), continuing education (75%), and opportunities (74%) were the top choices to increase engagement. National initiatives (47%), preventative measures (35%), and research endeavors (31%) were the top avenues for organizational engagement. These varied by income level, suggesting that the vision and priorities vary by baseline resource setting.

Conclusions

We have identified knowledge and practice gaps among health care professionals on the bidirectional relationship between kidney disease and climate change in a multinational context and several avenues to increase their engagement.

Climate change and human health: a primer on what women's health physicians can do on behalf of their patients and communities

PURPOSE OF REVIEW

To describe the current state of knowledge on the impact on climate change on women's health and to highlight opportunities for healthcare providers to serve as advocates and subject matter experts.

RECENT FINDINGS

Healthcare providers are a uniquely respected voice in society but have not used this advantage to advocate for their communities and participate in mitigation, adaptation, and resiliency efforts on behalf of their patients and communities.

SUMMARY

Healthcare providers feel that climate change is real, is human caused, and is currently or will shortly negatively impact their patients. They feel unprepared to serve as leaders and advocates due to time limitations and a knowledge gap. Resources in the current climate movement can help close this gap.

Climate Communication, Public Health, and Social Media: Examining the Role of Health Agencies in Addressing the Impacts of Climate Change on Human Health

The impacts of climate change on human health are a critical public health concern, with previous studies highlighting its clear effects on well-being. Understanding how state and territorial health agencies (STHAs) are addressing these emerging risks is important. This study conducted 26 in-depth interviews across the U.S. to explore the perceptions and communication strategies of STHA officials regarding climate change's impact on human health. Additionally, the study sought to identify the primary challenges faced by these officials to effectively communicate the impacts. Thematic analysis of the data revealed three major themes: community building and coalitions, climate denialism on social media, and misinformation about climate change and its effects on human health. These findings offer valuable insights for climate change and public health communication. The importance of the STHAs' development of technical and informational capacity to effectively communicate climate-related risks and threats is emphasized.

Does Climate Change Affect Health? Beliefs from the Health Information National Trends Survey

Climate change is currently and will continue impacting human health, however, beliefs about the level of threat vary by demographics, region, and ideology. The purpose of this study was to assess factors related to climate change and health beliefs using cross-sectional data from the Health Information National Trends Survey (HINTS). Data from 5,075 respondents in the 2022 iteration of HINTS was used for this study. Chi-square tests were used to evaluate demographic differences among those who believe climate change will harm health a lot compared to some, a little, or not at all. Generalized ordinal logistic regression models were used to examine the relationship between the belief that climate change will harm health and independent variables regarding trust in scientists, health recommendations from experts, and demographic characteristics. Female, Black, Hispanic, and college graduate respondents had higher odds and people in the Southern U.S. those aged 35-49, 50-64, and 75years or older had significantly lower odds of believing climate change would harm their health. Those who trust information about cancer from scientists and those that believe health recommendations from experts conflict or change had higher odds of believing climate change would harm health. Our analysis highlights factors that impact climate change and health beliefs, which may provide targets for tailoring public health messages to address this issue.

Knowledge, behaviours, practices, and expectations regarding climate change and environmental sustainability among health workers in France: a multicentre, cross-sectional study

BACKGROUND

Faced with climate change, hospitals are confronted with a dual challenge. On one hand, they need to embark on a far-reaching ecological transformation to reduce their contribution to greenhouse gas emissions and other environmental impacts; on the other hand, they need to limit the effects of climate change on their activities. We aimed to evaluate the knowledge, behaviours, practices, and expectations of health workers in French hospitals regarding climate change and environmental sustainability.

METHODS

This multicentre, cross-sectional study was carried out in six French hospitals from June 1, 2021 to Dec 31, 2022. All health workers at the hospitals were eligible to participate and were recruited through internal publicity. We designed a structured questionnaire consisting of five parts: participant characteristics, knowledge and perceptions of climate change, pro-environmental behaviours, practices concerning environmental sustainability actions, and expectations. A multilevel logistic regression model was used to evaluate associations between the knowledge, behaviours, and practices of health workers and the characteristics of the health workers and hospitals.

FINDINGS

Of 57 034 health workers across the six hospitals, 4552 (8·0%) participated in the study. Of those for whom gender data were available, 3518 (78·2%) participants were women and 979 (21·8%) were men. Participants considered energy consumption (71·0%) and waste and discharges related to medical activities (55·6%) and non-medical activities (50·2%) to be the three activities with the greatest environmental impact. On a scale of 1 (not a priority) to 10 (high priority), the median rating attributed by the participants to the commitment of their hospitals to ecological transformation was 5·0 (IQR 3·0-6·0). 1079 (23·7%) of 4552 participants had already initiated at least one environmental sustainability action in their hospital. Barriers reported by participants to the implementation of environmental sustainability-related projects were the lack of dedicated time (40·4%), hierarchical support (32·5%), methodological support (28·9%), and access to training (23·7%). The presence of a sustainable development steering committee, especially one with more than 5 years of activity, was positively associated with health workers feeling better informed about the ecological transformation of their hospital (adjusted odds ratio 1·78 [95% CI 1·29-2·45]), having better knowledge of the environmental impacts of their hospital (1·83 [1·32-2·53]), and initiating a larger number of environmental sustainability actions (1·74 [1·33-2·29]).

INTERPRETATION

We showed that health workers in French hospitals seem to be committed to the ecological transformation of their workplaces, and identified some drivers and barriers to further support these essential transformations. There is an urgent need to bolster training for all health workers, enhance structural frameworks within hospitals, and encourage future interdisciplinary research on the vulnerability of health-care facilities to climate change.

FUNDING

The University Hospital of Poitiers.

Climate Change Harm Perception Among U.S. Adults in the NCI Health Information National Trends Survey, 2022

PURPOSE

To examine associations between 1) sociodemographics and 2) trust in health information sources with climate change harm perception.

METHODS

Weighted adjusted logistic regression models examined correlates of climate change harm perception (harm vs no harm/don't know) among a nationally representative sample of U.S. adults (2022, n = 5585).

RESULTS

Sixty-four percent of U.S. adults believed climate change will harm their health. College education (vs high school or less) (AOR 1.7, 95% CI 1.3, 2.2) and having greater trust in doctors (AOR 1.4, 95% CI 1.2, 1.7), scientists (aOR 1.8, 95% CI 1.6, 2.0), and government health agencies (AOR 1.7, 95% CI 1.5, 1.9) for health information were associated with believing climate change harms health. Conversely, greater trust in religious organizations was associated with 16% lower odds of believing climate change harms health (95% CI .74, .94).

CONCLUSIONS

Climate change harm perception varied by sociodemographics and trust in health information source. Health communication delivered via alternative and diverse channels could expand the reach of climate and health messaging and ultimately increase public awareness and support for measures to mitigate the health impacts of climate change.

The mediating role of pro-environmental attitude and intention on the translation from climate change health risk perception to pro-environmental behavior

Climate change is a serious environmental issue appearing in China. As a public service institution operating around the clock, the negative impact of hospitals on the environment is evident, promoting their workers' pro-environmental behavior (PEB) through increasing climate change health risk perception (CHRP) is an effective method to protect the environment and achieve sustainable development. This study investigates how CHRP shapes pro-environmental attitude (PEA), pro-environmental intention (PEI), and pro-environmental behavior (PEB) among hospital workers. Using structural equation modeling (SEM) to determine the chain of causation from CHRP to PEB among hospital workers. The result shows that CHRP positively affects PEA and PEI, and PEI positively affects their PEB. In addition, although CHRP has no significant direct effect on PEB, it can play a crucial indirect effect through the mediating role of PEI. Moreover, the result of multiple regression shows that there are significant differences regarding PEA, PEI, and PEB.

How climate change degrades child health: A systematic review and meta-analysis

BACKGROUND

Children are more vulnerable than adults to climate-related health threats, but reviews examining how climate change affects human health have been mainly descriptive and lack an assessment of the magnitude of health effects children face. This is the first systematic review and meta-analysis that identifies which climate-health relationships pose the greatest threats to children.

OBJECTIVES

We reviewed epidemiologic studies to analyse various child health outcomes due to climate change and identify the relationships with the largest effect size. We identify population-specific risks and provide recommendations for future research.

METHODS

We searched four large online databases for observational studies published up to 5 January 2023 following PRISMA (systematic review) guidelines. We evaluated each included study individually and aggregated relevant quantitative data. We used quantitative data in our meta-analysis, where we standardised effect sizes and compared them among different groupings of climate variables and health outcomes.

RESULTS

Of 1301 articles we identified, 163 studies were eligible for analysis. We identified many relationships between climate change and child health, the strongest of which was increasing risk (60 % on average) of preterm birth from exposure to temperature extremes. Respiratory disease, mortality, and morbidity, among others, were also influenced by climate changes. The effects of different air pollutants on health outcomes were considerably smaller compared to temperature effects, but with most (16/20 = 80 %) pollutant studies indicating at least a weak effect. Most studies occurred in high-income regions, but we found no geographical clustering according to health outcome, climate variable, or magnitude of risk. The following factors were protective of climate-related child-health threats: (i) economic stability and strength, (ii) access to quality healthcare, (iii) adequate infrastructure, and (iv) food security. Threats to these services vary by local geographical, climate, and socio-economic conditions. Children will have increased prevalence of disease due to anthropogenic climate change, and our quantification of the impact of various aspects of climate change on child health can contribute to the planning of mitigation that will improve the health of current and future generations.

Change in emotional distress, anxiety, depression and PTSD from pre- to post-flood exposure in women residing in low-income settings in South Africa

Floods are increasing in frequency and may increase the risk for experiencing emotional distress, anxiety, depression and PTSD. The aim of this study was to determine the extent of damage, loss, injury and death resulting from floods that occurred in and around the city of Durban, South Africa, in April 2022, and associated changes in mental health pre- to post-floods in a low-income setting. Seventy-three women between the ages of 18 and 45, residing in flood affected, low-income settings, were interviewed prior to the floods occurring. Mental health measures were repeated with 69 of the 73 women during the post-flood interview along with a questionnaire measuring flood-related exposures. Loss of infrastructure (lacked access to drinking water, electricity, fresh food, could not travel to work, had to stay in a shelter and could not get hold of friends or family) was a predictor of post-flood change in levels of emotional distress and anxiety. Higher levels of prior trauma exposure were associated with higher post-flood levels of emotional distress. Higher pre-flood food insecurity was also associated with higher post-flood anxiety. Women affected by poverty, food insecurity and a history of trauma are vulnerable to the additive adverse mental health effects of floods. Proactive approaches to diminishing the impact of floods on the livelihood of women is needed and post-flood relieve efforts may be more affective if they are enhanced by providing mental health support.

China's anthropogenic N2O emissions with analysis of economic costs and social benefits from reductions in 2022

We assess China's overall anthropogenic N2O emissions via the official guidebook published by Chinese government. Results show that China's overall anthropogenic N2O emissions in 2022 were around 1593.1 (1508.7-1680.7) GgN, about 47.0 %, 27.0 %, 13.4 %, 4.9 %, and 7.7 % of which were caused by agriculture, industry, energy utilization, wastewater, and indirect sources, respectively. Maximum reduction rate for N2O emissions from agriculture, industry, energy utilization, wastewater, and indirect sources can achieve 69 %, 99 %, 79 %, 86 %, and 48 %, respectively, in 2022. However, given current global scenarios with a rapidly changing population and geopolitical and energy tension, the emission reduction may not be fully fulfilled. Without compromising yields, China's theoretical minimum anthropogenic N2O emissions would be 600.6 (568.8-633.6) GgN. In terms of the economic costs for reducing one kg of N2O-N emissions, the price ranged from €12.9 to €81.1 for agriculture, from €0.08 to €0.16 for industry, and from €104.8 to €1571.5 for energy utilization. We acknowledge the emission reduction rates may not be completely realistic for large-scale application in China. The social benefits gained from reducing one kg of N2O-N emissions in China was about €5.2, indicating anthropogenic N2O emissions caused a loss 0.03 % of China's GDP, but only justifying reduction in industrial N2O emissions from the economic perspective. We perceive that the present monetized values will be trustworthy for at least three to five years, but later the numerical monetized values need to be considered in inflation and other currency-dependent conditions.

A long road ahead. A German national survey study on awareness and willingness of surgeons towards the carbon footprint of modern surgical procedures

Background

Climate change may well be the "largest threat" to humankind. Changes to our climate system lead to a decrease in global health. The healthcare sector presents one of the largest carbon footprints across all industries. Since surgical departments have one of the largest carbon footprints within the healthcare sector, they represent an area with vast opportunities for improvement. To drive change, it is vital to create awareness of these issues and encourage engagement in changes among people working in the healthcare industry.

Methods

We conducted an anonymous cross-sectional survey study to assess awareness among surgeons regarding the impact of healthcare systems on climate change. The questions were designed to investigate surgeons' willingness to accept and promote changes to reduce carbon footprints. Participants included surgical professionals of all ages and levels of expertise.

Results

A total of 210 participants completed the survey in full and were included in the evaluation. Sixty percent emphasized a lack of information and the need for personal education. Over 90 % expressed concern for the environment and a strong desire to gain new insights. Provided that clinical performance remains the same, more than 70 % are willing to embrace carbon-friendly alternatives. In this context, all participants accepted the additional time required for training and initially increased personal efforts to achieve equal performance.

Conclusion

Limited awareness and information about carbon footprints were observed in surgical departments in German hospitals. Nevertheless, the vast majority of surgeons across all age groups are more than willing to acquire new insights and adapt to changes in order to reduce energy consumption and carbon dioxide production.

Keeping Sane in a Changing Climate: Assessing Psychologists' Preparedness, Exposure to Climate-Health Impacts, Willingness to Act on Climate Change, and Barriers to Effective Action

Evidence of the impact of climate change on mental health is growing rapidly, and healthcare professionals are being called to be active participants in protecting the population's health. Yet, little is known about psychologists' understanding of climate-health impacts and their role in mitigation actions. We surveyed Australian psychologists (N = 59) to examine preparedness in identifying and managing the impact of climate change on mental health, exposure to climate-health impacts, willingness to act, and barriers to acting on climate change. Data was analysed through descriptive and associative methods. We found that participants are not prepared to identify and manage mental health presentations related to climate change, and they are not engaged in climate change mitigation. We identified that a lack of knowledge of climate-health impacts and tackling and mitigation strategies, in addition to ethical concerns, were the main barriers to engagement with communication and advocacy. With the impacts of climate change on mental health expected to soar, there is a clear and urgent need to prepare the psychological workforce to address this public health issue by establishing professional education programs and reframing climate change as a health crisis.

Role of public health professionals in the climate and ecological crisis: a qualitative study

BACKGROUND

The climate and ecological emergency is the single biggest health threat facing humanity, yet it is not clear to what extent the public health workforce have been involved in work on this topic. This research aimed to establish what public health consultants working in local authorities in England perceive their role to be, whether the climate crisis is seen as a core component of public health and to identify barriers to action.

METHODS

Semi-structured interviews were undertaken with a purposive sample (n=11) of local authority public health consultants in England. Participants were recruited via public health organisations, social media or snowballing. Thematic content analysis was used to identify codes and themes.

RESULTS

Public health professionals have started work on climate change but reported being unclear about their role and feeling isolated working on this topic. Barriers to action included shortage of financial resources, communication tools and capacity, limited sharing of best practice, lack of local expertise and conflict between the need for action on climate change and other urgent issues.

CONCLUSION

We highlight the need to urgently address existing barriers to enable this important part of the public health workforce to play their role in tackling the climate and ecological crisis.

Time for change: compliance with RCS green theatre checklist-facilitators and barriers on the journey to net zero

Background

Climate change is an era-defining health concern, with healthcare related emissions paradoxically compounding negative impacts. The NHS produces 5% of the UK's carbon footprint, with operating theatres a recognised carbon hotspot. NHS England aims to become Net Zero by 2045. Consequently, UK Royal Colleges of Surgery have published guidance to foster an evidence-based sustainable transformation in surgical practice.

Methods

A single-centre quality improvement project was undertaken, aiming to provide an overview of sustainable practice locally. The Intercollegiate "Green Theatre Checklist" was taken as an audit standard, focusing on "preparing for surgery" and "intraoperative equipment" subsections. Any general surgical procedure was eligible for inclusion. Usage of reusable textiles, non-sterile gloves, catheters, antibiotics, alcohol vs. water-based scrub techniques, skin sterilisation choices, and skin closure materials were recorded. Baseline data collection occurred over a 3 week period, followed by dissemination of results locally via clinical governance meetings and poster displays. A re-audit of practice was conducted using the same methodology and duration.

Results

Datasets 1 (n = 23) and 2 (n = 23) included open (n = 22), laparoscopic (n = 24), elective (n = 22) and non-elective (n = 24) cases. Good practice was demonstrated in reusable textiles (trolley covers 96%, 78%, drapes 100%, 92%) however procurement issues reduced otherwise good reusable gown use in Dataset 2 in (90%, 46%). No unnecessary catheter use was identified, and loose skin preparations were used unanimously. Uptake of alcohol-based scrubbing techniques was low (15%, 17%) and unnecessary non-sterile glove use was observed in >30% of procedures. All laparoscopic ports and scissors were single use. Carbon footprints were 128.27 kgCO2e and 117.71 kgCO2e in datasets 1 and 2 respectively.

Conclusion

This project evidences good practice alongside future local focus areas for improved sustainability. Adoption of hybrid laparoscopic instruments, avoiding unnecessary equipment opening, and standardising reusable materials could reduce carbon and environmental impact considerably. Successful implementation requires considered procurement practices, improved awareness and education, clear leadership, and a sustained cultural shift within the healthcare community. Collaboration among professional institutions and access to supporting evidence is crucial in driving engagement and empowering clinicians to make locally relevant changes a reality.

Climate-specific health literacy in health professionals: an exploratory study

Background

Health professionals such as physicians and nurses may play an important role in the transformation process towards a healthy, sustainable and climate-sensitive society. However, little is known about their climate-specific health literacy. This study aimed to assess knowledge regarding climate change and its impacts on health and climate-specific health literacy in health professionals.

Methods

In July/August 2022, a cross-sectional, questionnaire-based study was carried out at the University Hospital Regensburg, Germany, to assess climate-specific health literacy in nurses and physicians from various clinical specialties. Descriptive and exploratory statistical analyses were performed.

Results

The study population consisted of 142 participants (57.7% women; response rate: 24,7%). Most participants (93%) considered climate change to be highly relevant. However, only 12% of respondents stated to be very well informed regarding the general consequences of climate change. Although 57% of all participants had never mentioned climate change in relation to health to their patients, participants with higher levels of knowledge regarding the effects of climate change were more likely to mention it compared to those with lower levels of knowledge. The most frequently stated obstacle to integrate the topic of climate change in clinical work was lack of time during work (79%), not enough information (42%) and lacking materials (39%). Differences between health professions were apparent.

Conclusion

The results of our survey suggest that the current state of climate-specific health literacy differs between different groups of health professionals. There is a need to improve health professionals' levels of climate-specific health literacy and to increase the potential in interprofessional cooperation regarding planetary health.

Barriers to climate change and health research in India: a qualitative study

OBJECTIVES

Almost a quarter of the global burden of disease and mortalities is attributable to environmental causes, the magnitude of which is projected to increase in the near future. However, in many low- and middle-income settings, there remains a large gap in the synthesis of evidence on climate-sensitive health outcomes. In India, now the world's most populous country, little remains known about the impacts of climate change on various health outcomes. The objective of this study is to better understand the challenges faced in conducting climate change and health research in Puducherry, India.

DESIGN AND SETTING

In this study, we employed key informant interviews to deepen the understanding of the perceived research barriers in Puducherry. The findings were analysed using data-driven qualitative thematic analysis to elaborate the major perceived barriers to conducting environmental health research.

PARTICIPANTS

This study was conducted among 16 public health professionals, including medical researchers, and professionals involved in environmental policies and planning in Puducherry.

RESULTS

We identify three key barriers faced by public health professionals as key stakeholders, namely: (1) political and institutional barriers; (2) education and awareness barriers; and (3) technical research barriers. We show there is a need, from the professionals' perspective, to improve community and political awareness on climate change and health; strengthen technical research capacity and collaboration among researchers; and strengthen health surveillance, resource allocation and access to health data for research.

CONCLUSION

Evidence informed policies and interventions are a key element in the adaptation response for countries. In the context of the paucity of data on environmental health from India, despite recognised climate change related health vulnerabilities, these findings could contribute to the development and improvement of relevant interventions conducive to a strong research environment.

Climate change and health in rural mountain environments: summary of a workshop on knowledge gaps, barriers, and opportunities for action

Climate change and its associated impacts on human health are serious and growing challenges. Yet, despite elevated health disparities, unique underlying vulnerabilities, and distinctive ecosystems, little research has been conducted in rural mountain environments to understand climate-health interactions. The climate change and health workshop in rural mountain environments was held at Appalachian State University in Boone, North Carolina, United States, to address these research gaps. Experts, community members, and students from diverse disciplines engaged in World Café brainstorms and open-ended discussions to highlight needs across seven research priority themes, which focused on rural southern Appalachia but are applicable to other rural mountain environments: (1) anticipating climate change-driven environmental changes specific to rural mountain environments; (2) identifying and reaching vulnerable populations; (3) building health care access security during weather disasters; (4) building mental health support security in the context of climate change; (5) vector-borne disease resilience; (6) building food security in the context of climate change; and (7) public education and conversations of climate change. This report summarizes the workshop findings and provides a template for future research at the intersection of climate and health, including but not limited to establishing multi-sector and interdisciplinary working groups with clear objectives, enhancing knowledge and understanding of key issues, as well as acting collaboratively and engaging with stakeholders to build resilience in rural mountain environments to address the effects of climate change on human health.

Integrating climate change and health topics into the medical curriculum - a quantitative needs assessment of medical students at Heidelberg University in Germany

Objectives

Climate change (CC) is of major importance for physicians as they are directly confronted with changing disease patterns, work in a greenhouse gas intensive sector and can be potential advocates for healthy people on a healthy planet.

Methods

We assessed third to fifth year medical students' needs to support the integration of CC topics into medical curricula. A questionnaire with 54 single choice-based items was newly designed with the following sections: role perception, knowledge test, learning needs, preference of educational strategies and demographic characteristics. It was administered online to students at Heidelberg medical faculty. Data sets were used for descriptive statistics and regression modelling.

Results

72.4% of students (N=170, 56.2% female, 76% aged 20-24 years) (strongly) agreed that physicians carry a responsibility to address CC in their work setting while only 4.7% (strongly) agreed that their current medical training had given them enough skills to do so. Knowledge was high in the area of CC, health impacts of CC, vulnerabilities and adaptation (70.1% correct answers). Knowledge gaps were greatest for health co-benefits and climate-friendly healthcare (55.5% and 16.7% of correct answers, respectively). 79.4% wanted to see CC and health included in the medical curriculum with a preference for integration into existing mandatory courses. A multilinear regression model with factors age, gender, semester, aspired work setting, political leaning, role perception and knowledge explained 45.9% of variance for learning needs.

Conclusion

The presented results encourage the integration of CC and health topics including health co-benefits and climate-friendly healthcare, as well as respective professional role development into existing mandatory courses of the medical curriculum.

'I don't really associate climate change with actual people's health': a qualitative study in England of perceptions of climate change and its impacts on health

OBJECTIVES

The health impacts of climate change are increasing, but qualitative evidence on people's perceptions is limited. This qualitative study investigated people's perceptions of climate change and its impacts on health.

STUDY DESIGN

This was an online study using semistructured interviews.

METHODS

A total of 41 semistructured interviews were conducted in 2021 with members of the public aged ≥15 years living in England, recruited via community-based groups. Data were analysed using reflexive thematic analysis.

RESULTS

Participants were concerned about climate change, which was often perceived as extreme weather events happening elsewhere. Changes in the UK's seasons and weather patterns were noted, but participants were uncertain whether these changes resulted from climate change. Participants often struggled to identify health impacts of climate change; where health impacts were described, they tended to be linked to extreme weather events outside the United Kingdom and their associated threats to life. The mental health impacts of such events were also noted.

CONCLUSIONS

The study found that most participants did not perceive climate change to be affecting people's health in England. This raises questions about whether framing climate change as a health issue, an approach advocated for countries less exposed to the direct effects of climate change, will increase its salience for the British public.

The Impact of Temperature on 24-Hour Movement Behaviors among Chinese Freshmen Students

BACKGROUND

Human populations worldwide have experienced substantial climate change issues. Gaps in scientific literature remain regarding the relationship between temperature and 24-hour movement behavior among people. The purpose of this study is to examine the impact of temperature on 24-hour movement behavior including physical activity (PA), sedentary behavior (SB) and sleep duration among university students living in Beijing, China.

METHODS

We conducted follow-up health surveys on 44,693 freshmen students enrolled at Tsinghua University from 2012 to 2018. PA and SB were measured by using the short version of the International Physical Activity Questionnaire (IPAQ-s); sleep duration was estimated by using The Pittsburgh Sleep Quality Index (CPSQI). Corresponding temperature data measured by the Beijing Meteorological Service were collected to include average daily temperature from the nearest weather station to Tsinghua university. The data were analyzed using linear individual fixed-effect regressions.

RESULTS

An increase in temperature (temperature range 2.29-28.73 °C) by 1 °C was associated with an increase in 0.66 weekly minutes of vigorous physical activity (VPA) (95% confidence interval [CI] = 0.49, 0.82), an increase in 0.56 weekly minutes of moderate physical activity (MPA)(95% CI = 0.32, 0.79), an increase in 1.21 weekly minutes of moderate to vigorous physical activity (MVPA) (95% CI = 0.90, 1.53), an increase in 0.55 weekly minutes of walking (95% CI = 0.31, 0.78), an increase in 1.76 weekly minutes of total PA (95% CI = 1.35, 2.17), and a reduction in 1.60 weekly minutes of sleeping (95% CI = -2.09, -1.11). There was no significant correlation between temperature and sedentary behavior among participants.

CONCLUSIONS

Temperature was significantly positively correlated with physical activity levels in the Chinese freshmen students, and significantly negatively correlated with sleep duration. Replication of this study is warranted among various populations within China. The evidence of this novel study focused on understanding the relationship between climate change and 24-hour movement behaviors among people for developing effective adaptation strategies to climate change to improve people's health behavior. This study has important implications for future study, as knowledge of the impact of temperature on movement behavior may help in the interpretation of their results and translate into improving people's health behavior.

"Climate Change and Health?": Knowledge and Perceptions among Key Stakeholders in Puducherry, India

Climate change has far-reaching impacts on human health, with low- and middle-income countries, including India, being particularly vulnerable. While there have been several advances in the policy space with the development of adaptation plans, little remains known about how stakeholders who are central to the strengthening and implementation of these plans perceive this topic. We conducted a qualitative study employing key interviews with 16 medical doctors, researchers, environmentalists and government officials working on the climate change agenda from Puducherry, India. The findings were analysed using the framework method, with data-driven thematic analysis. We elucidated that despite elaborating the direct and indirect impacts of climate change on health, there remains a perceived gap in education and knowledge about the topic among participants. Knowledge of the public health burden and vulnerabilities influenced the perceived health risks from climate change, with some level of scepticism on the impacts on non-communicable diseases, such as cardiovascular diseases. There was also a felt need for multi-level awareness and intervention programmes targeting all societal levels along with stakeholder recommendations to fill these gaps. The findings of this study should be taken into consideration for strengthening the region's climate change and health adaptation policy. In light of limited research on this topic, our study provides an improved understanding of how key stakeholders perceive the impacts of climate change on health in India.

Understanding the Impact of the COVID-19 Pandemic on the Perception and Use of Urban Green Spaces in Korea

Faced with the prospect that the impact of the COVID-19 pandemic and climate change will be far-reaching and long-term, the international community is showing interest in urban green space (UGS) and urban green infrastructure utilization as a solution. In this study, we investigated how citizens' perceptions and use of UGS have changed during COVID-19. We also collected their ideas on how UGS can raise its usability. As a result, more people became to realize the importance of UGS. In particular, the urban environmental purification function from UGS was recognized as giving great benefits to respondents. On the other hand, the patterns of UGS use were mixed with decreasing UGS use to maintain social distancing or increasing UGS use to maintain health or substitute other restricted facilities. More than half of respondents had their UGS visit patterns impacted by COVID-19. In particular, the increase rate of UGS use was rather high in the group that seldom used UGS before COVID-19. In addition, they increased the use of UGS to replace other limited facilities, and thus tended to demand an increase in rest facilities. Based on these results, this paper suggested securing social support and sustainability for the policy by reflecting users' demand in landscape planning related to the increase of UGS in the city. This study can contribute to improving the resilience of UGS and the sustainability of urban space planning.

Perceptions of the health impacts of climate change among Canadians

BACKGROUND

Understanding public perceptions of the health risks of climate change is critical to inform risk communication and support the adoption of adaptive behaviours. In Canada, very few studies have explored public understandings and perceptions of climate impacts on health. The objective of this study was to address this gap by exploring perceptions of the link between climate change and health.

METHODS

We conducted a survey of Canadians (n = 3,014) to address this objective. The 116-question survey measured prior consideration of the link between climate change and health, affective assessment of climate health impacts, unprompted knowledge of climate health impacts, and concern about a range of impacts. ANOVA tests were used to assess differences among sociodemographic groups.

RESULTS

Overall, Canadian's have a similar level of concern about health impacts of climate change compared with concern about other impacts (e.g. biophysical, economic, and national security). Among health-related impacts, respondents were more concerned about impacts on water, food and air quality, compared with impacts on mental health, infectious diseases and heat-related illnesses. There were differences among sociodemographic groups; women were significantly more concerned than men about all of the health-related impacts; respondents with a high school level of education were significantly less concerned about all health-related impacts compared with respondents with more education; and respondents on the political left were more concerned with those in the political centre, who were more concerned than those on the political right.

CONCLUSION

There is emerging literature suggesting that framing communication around climate change in terms of the health risks it poses may increase perceptions of the proximity of the risks. These results suggest that it is important to be specific in the types of health risks that are communicated, and to consider the concerns of the target sociodemographic groups. The differential knowledge, awareness, and concern of climate health impacts across segments of the Canadian population can inform targeted communication and engagement to build broader support for adaptation and mitigation measures.

Communication research to improve engagement with climate change and human health: A review

Because of the world's dependence on fossil fuels, climate change and air pollution are profoundly harming both human and planetary health. Fortunately, climate solutions are also health solutions, and they present both local and global opportunities to foster cleaner, healthier, and safer communities. In this review, we briefly discuss the human health harms of climate change, climate and health solutions, and provide a thorough synthesis of social science research on climate and health communication. Through our review, we found that social science research provides an evidence-based foundation for messaging strategies that can build public and political will for climate and health solutions. Specifically, messages that convey the health harms of climate change and highlight the health benefits of climate solutions may be especially effective in building this public and political will. We also found that health professionals are trusted sources of information about climate change, and many have shown interest in engaging with the public and policymakers about the health relevance of climate change and clean energy. Together, the alignment between message strategies and the interest of highly trusted messengers strongly suggests the potential of health students and health professionals to create the conditions necessary to address climate change as a public health imperative. Therefore, our review serves as a resource for those interested in communicating about climate change and health and suggests that social scientists can continue to support practitioners with research and advice on the most effective communication strategies.

Five U.S. Dietary Patterns and Their Relationship to Land Use, Water Use, and Greenhouse Gas Emissions: Implications for Future Food Security

The U.S. agri-food system is a driver of climate change and other impacts. In order to achieve environmental targets that limit global mean temperature rise ≤2 °C, a shift in American dietary patterns is critical. The purpose of this study was twofold: (1) to determine the environmental impact (i.e., land use, water use, and GHG emissions) related to consumption of five U.S. dietary patterns (i.e., Current U.S., the Healthy U.S., Mediterranean, Healthy Vegetarian, and Vegan), and (2) to determine the specific impact of each food group in each dietary pattern on the three environmental indicators. This study utilized existing datasets to synthesize information related to the study's environmental indicators and food production and connected these data to the current U.S. diet and the USDA-defined diets. Results indicate that the three omnivore diets contributed the greatest to GHG emissions, land use and water use. The Vegan diet scored the lowest across all indicators, although the water required for plant-based protein nearly offset other water gains. For the omnivore diets, red meat and dairy milk contributed the most to each environmental indicator. By considering sustainability as well as health outcomes in their recommendations in the Dietary Guidelines, the USDA can have a critical role in shifting diets necessary to alter climate change trends.

Climate change and health care facilities: A risk analysis framework through a mapping review

INTRODUCTION

Climate change (CC) has been identified as the biggest global health threat of the 21st century. Although health care facilities (HCF) play a central role in the care of populations, there has been no comprehensive assessment of the impact of CC on HCF. The objective of our study was to highlight the components of HCFs affected by CC through a mapping review of the literature.

METHODS

To meet our objective, we first assessed the place of HCFs in relation to CC in the scientific literature and in the Intergovernmental Panel on Climate Change (IPCC) reports. Bibliometric data from the PubMed database were analyzed between 1979 and 2021 to assess the penetration of keywords on CC alone, and in relation to health and HCF in particular. Second, we analyzed the changes in HCF keywords in the IPCC reports. Finally, we conducted a mapping review in five databases, of the international scientific literature published between 1979 and 2019, and identified the components of HCF affected by CC using the Ishikawa diagram.

RESULTS

From the 2000s, the number of publications on CC and HCF increased gradually with 137 articles in 2005, and even more sharply since 2008 with 358 articles published and 813 in 2021. Even though CC is only recently present in the biomedical literature, all climatic events (warming and heatwaves, droughts, wildfires, storms, hurricanes and cyclones, floods and sea-level rise, and other indirect effects) have had an impact on at least one component of HCF.

CONCLUSION

HCFs are already impacted, in all their components, by CC. By enhancing our understanding of the impacts of CC on HCF, this work could contribute to the engagement of health professionals in the implementation of mitigation and adaptation actions, thereby limiting the consequences of CC on patient care.

To pollute or not to pollute? Decreasing the ecological footprint of pediatrics in the COVID-19 era

The climate crisis impacts child health, increasing the burden of pediatric healthcare. During the COVID-19 pandemic, the ecological footprint of pediatric healthcare has significantly increased due to the use of personal protective equipment and the provision of large-scale testing and vaccination against COVID-19. The situation calls for coordinated action to make pediatric healthcare more resource-efficient. To achieve this goal, pediatricians should work together with children and parents in order to appropriately minimize the use of electricity, water, paper and plastic and promote environmental sustainability in healthcare and beyond. The present article discusses the main sources of environmental pollution in pediatric healthcare and proposes evidence-based solutions.

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

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

Public View of Public Health Emergencies Based on Artificial Intelligence Data

In the current environment where the network and the real society are intertwined, the network public view of public emergencies has involved in reality and altered the ecology of communal public views in China. A new online court of influence has been created, and it affected the trend of events. As the main type of public emergencies, public health emergencies are directly related to people's health and life insurance. Therefore, the public often pays special attention. At present, correct media guidance plays an irreplaceable and important role in calming people's hearts and stabilizing social order. If news and public view are left unchecked, it is likely to cause panic among the people. However, in reality, public view research has always been a research object that is difficult to intelligentize and quantify. Based on such a realistic background, the article conducts a research on public view of public health emergencies based on artificial intelligence data analysis. This study designs an expert system for network public view and optimizes the algorithm for the key problem: SFC deployment. Finally, the system was put into real news and public opinion research on new coronavirus epidemic prevention, and experimental tests were carried out. The experimental results have shown that in the new coronavirus incident, the nuclear leakage incident, and the epidemic prevention policy, the data obtained by the public through the Internet are 50%, 68.06%, and 64.35%, respectively. For the system function in this study, both ICSO and IPSO are far better than the optimization results of CSO and PSO. For most of the test functions, IPSO is better than ICSO's optimization results, which better fulfills the needs of the research content. This study will make an in-depth analysis of the evolution process of online public opinion on public emergencies from the macro-, meso-, and micro-perspectives, in order to analyze the dissemination methods and internal evolution mechanism of various public emergencies of online public opinion, which provides countermeasures and suggestions for the government to guide and manage network public opinion.

The third degree: climate change and reproductive health

Climate change is a public health emergency, yet the medical community has been inconsistent in its understanding and engagement of the crisis. Reproductive endocrinology and infertility and reproductive biology will be impacted broadly by the changing climate. This Views and Reviews hopes to enlist reproductive endocrinology and infertility specialists to first understand the issues and then take action to support mitigation and accommodation efforts.