Climate Change, Environmental Disasters, and Health Inequities: The Underlying Role of Structural Inequalities

Intergenerational inequity from hydrological drought in a warming world

As warmer temperatures enhance atmospheric moisture, hydrological droughts tend to intensify in most regions of the globe. Consequently, younger generations are expected to face a more severe risk of hydrological drought during their lifetimes, emphasizing the critical issue of intergenerational inequity due to climate change. To quantify exposure to hydrological drought across generations, we constructed a cascade model chain for drought simulation using hybrid terrestrial models, based on 5 GCM outputs under SSP5-85, five hydrological models and a deep learning model. We then projected future univariate and bivariate hydrological drought evolution in 4091 river basins, and quantified lifetime exposure to drought for the age groups born in 2020 and 1960. Drought severity and duration are projected to increase substantially in the Eastern America, Southern Brazil and Western Europe, over 79 % of basins. Extreme droughts far beyond historical records are expected to become more frequent and impact Western Europe in particular. Of note, the exposure of the different age groups to hydrological drought shows a notable disequilibrium. Exposure of people born in 2020 to hydrological drought hazards is projected to increase by 12 % over the late 21st century compared to those born in 1960, indicating that the acceleration of climate change is expected to increase the lifetime risk of future generations. The exposure factor of the newborns is 1.4 times higher than that of 80 years of age under warming condition. Our findings underscore that future drought conditions under extreme warming pose a significant threat to the living conditions of younger generations.

Understanding climate change anxiety and anticipatory climate disaster stress: A survey of residents in a high-risk California county during wildfire season

BACKGROUND

With the increasing prevalence of climate-related disasters, psychological responses, including climate change anxiety and anticipatory climate disaster stress, have received heightened attention.

OBJECTIVE

We investigate the correlates of climate change anxiety and anticipatory climate disaster stress, as well as the nature of these psychological responses.

METHODS

At the start of the annual fire season (June to August 2023), we recruited a county-representative sample of n=813 residents of Lake County, in Northern California, to complete an anonymous online survey. Multiple regression analyses identified correlates of climate change anxiety and anticipatory climate disaster stress and explored how anxiety and stress were associated with disaster preparedness.

FINDINGS

Climate change anxiety, assessed via its cognitive-emotional impairment (odds ratio (OR)loss/injury=1.68; ORmedia=2.37) and functional impairment (ORloss/injury=1.68; ORmedia=2.63) subfactors, and anticipatory climate disaster stress (bloss/injury=0.15, bmedia=0.26) were associated with previous wildfire-induced loss/injury and media exposure to wildfire-related content. Anticipatory climate disaster stress was also associated with the frequency of being in an evacuation zone (b=0.05). Both the cognitive-emotional impairment subfactor of climate change anxiety (incidence rate ratio (IRR)=1.23) and anticipatory climate disaster stress (IRR=1.14) were associated with preparing an emergency kit and power outage supplies; anticipatory climate disaster stress was associated with evacuation intentions should an actual fire occur (b=0.12).

CONCLUSIONS

Prior experiences with climate disasters could explain people's psychological responses to climate change. These responses could be temporally appropriate and functionally adaptive, given the immediacy of a potential fire.

CLINICAL IMPLICATIONS

Climate change anxiety and anticipatory climate disaster stress should not be oversimplified as typical clinical symptoms because their presence might motivate adaptive self-protective behaviours in the face of an upcoming disaster.

Air Pollution Increases Healthcare Utilization Below Safe Thresholds in Individuals With Asthma

PURPOSE

Safety thresholds for air quality levels have been proposed to protect people from the harmful effects of air pollutants. However, the impacts of air pollutants on asthma, particularly at levels below these safe thresholds, remain unclear.

METHODS

We analyzed the associations between air pollutants (particulate matter of 10 μm or less in diameter [PM₁₀], particulate matter of 2.5 μm or less in diameter, sulfur dioxide [SO₂], carbon monoxide, ozone [O₃], and nitrogen dioxide) and healthcare utilization in 23,498 individuals with asthma in Seoul during the 2015-2017 season. The relative risk for healthcare utilization was assessed based on quantitative comparison (upper quartile vs. lower quartile) and non-linear concentration-response curves. Safety thresholds for air quality levels were determined according to the World Health Organization and Korean standards.

RESULTS

In quantitative analysis, healthcare utilization risk decreased for PM₁₀ and SO₂ but increased for O₃ on lag day 0, with no significant associations observed for other air pollutants. Non-linear analyses revealed significant concentration-response associations for all air pollutants, indicating increased risks of healthcare utilization on lag day 0. Notably, these increased risks occurred below proposed safety thresholds, with a steeper rise observed for asthma-related healthcare utilization within these ranges.

CONCLUSIONS

Exposure to 6 air pollutants was associated with an increased risk of healthcare utilization among individuals with asthma, with no safe exposure levels identified. The impact was more pronounced below current safety thresholds.

Long-term mental health trajectories across multiple exposures to climate disasters in Australia: a population-based cohort study

BACKGROUND

Tracking populations through increasingly frequent climate disasters and understanding what contributes to mental health risks is crucial for adaption and planning for a climate changed world. We aimed to examine mental health trajectories after consecutive climate-related disasters and assess differences in mental health outcomes by temporal proximity to previous disasters and risk profiles.

METHODS

Using longitudinal population-based Australian data from 2009 to 2019, people who experienced home damage from at least one disaster (flood, bushfire, or cyclone) were included in the exposure population and tracked from pre-disaster to post-disaster years after each exposure. Cumulative mental health effects of each sequential exposure were estimated through various mental health measures using a panel event study design with linear models in comparison to unexposed matched controls, pre-disaster baselines, and across stratified risk groups. The main mental health outcome was measured with the 5-item mental health inventory (MHI-5).

FINDINGS

Mental health effects became more severe with successive disasters. MHI-5 scores declined by 1·61 (95% CI -2·69 to -0·52) and 3·37 (-6·45 to -0·29) during the first and repeat disaster exposures, respectively, compared with the year preceding the first disaster. Recovery to a pre-disaster baseline was more delayed with repeat disaster exposures. There were greater declines in mental health when disasters were closer to the previous exposure (1-2 years apart) than further away (3 or more years). Risk factors that shape mental health trajectories either remained consistent across multiple exposures (social support as protective and long-term health conditions as risks) or became more salient during subsequent exposures (lower household income and rural areas more vulnerable to the mental health effects of repeat disasters).

INTERPRETATION

Additional disaster exposures were associated with greater declines in mental health and shifts in some risk factors. Multiple disaster exposures must be urgently considered in public health, welfare, and disaster services.

FUNDING

Australian Research Council.

Mitigating climate change impacts on health: a comparative analysis of strategies in Saudi Arabia and Lebanon

Introduction

Human activities are now adding rapidly more greenhouse gases to the atmosphere causing global warming which is one aspect of climate change, the greatest threat to public health. Therefore, this study aims to compare the health impacts of climate change on Saudi Arabia and Lebanon, and assessing their adaptation strategies in addressing climate change challenges.

Methodology

This study is a descriptive Comparative Analysis, this was performed by analyzing the available data on climate-related health outcomes: food insecurity, emergence of infectious disease and car accidents and by comparing trends and percentages between the two countries.

Results and discussion

Saudi Arabia and Lebanon has markable high CO2 emission, which negatively affect the health of people such as Food insecurity (in KSA: The estimated loss over the periods in all the crops ranges from 7 to 25%, in Lebanon: There is a decreased the growth of coveted crops, and increased the growth of weeds and pests), Road traffic accidents (approximately 1.3 million people die as a result of road traffic accidents and 20-50 million people suffer from other injuries.), and Emergence of infectious diseases (in KSA: an increase in 1°C of temperature caused a significant increase (15-25%) in malaria incidence, and increase in risk of food- borne diseases, in Lebanon: There is a vulnerability to the rise in food-borne and vector-borne diseases.). Forecasting the future for both countries reveal to a definite climate change occurring. Further actions could be implemented to overcome the negative health outcomes according to each country. Agriculture and Food Security, Use of renewable energy, and Awareness Campaigns on climate change and health are measures that could be implemented to face the outcomes of climate change. Interestingly, there are some organizations funding initiatives and activities in raising awareness of climate change.

Conclusion

Numerous sectors are impacted by climate change, which is a serious issue that requires immediate action. It has a substantial influence on many different sectors and leads to food instability, agricultural issues, an increase in infectious disease transmission, and a rise in traffic accidents. These elements require particular care, and appropriate action should be done to eliminate them.

Sociodemographic and geographic inequalities in exposure to projected hot and extreme summer days in England: A nationwide socio-spatial analysis

INTRODUCTION

Climate change is a global health emergency, with extreme heat events increasing morbidity, mortality, and hospitalisations, and exacerbating health and social inequalities. Global temperatures have risen by over 1.1 °C since pre-industrial times and could reach 2.5 °C or even 4.0 °C based on current policies. This study examined how projected climate change will vary geographically and by population sub-group in England, to assess whether these changes will affect existing health inequalities.

METHODS

We used small-area baseline (2001 to 2020) and climate projection data from the UK's Met Office, linking it to area-level sociodemographic (2019) and health data (2016/17 to 2020/21), including age, socioeconomic status, ethnicity, hospital admissions, and mortality. Summated numbers of hot and extreme summer days were plotted by area-level health and sociodemographic quintiles. Models assessed the association between area-level quintiles and the projected number of hot (>30 °C) and extreme (>35 °C) summer days under 2.5 °C and 4.0 °C global heating scenarios.

RESULTS

There were clear geographical variations in experiencing hot and extreme summer days, with the South of England seeing the highest increases. The pattern of projected temperature increases does not align with typical health inequalities, as less deprived areas will experience more hot and extreme summer days, while areas with larger ethnic minority populations will face a greater number.

CONCLUSION

Climate adaptation strategies are needed to two levels: (1) locally to support vulnerable population groups in coping with global heating; and (2) national and global strategies to prevent global temperatures from exceeding 2.5 °C or reaching 4.0 °C, given the severe population-level health risks such increases would entail.

Expert Review: Confronting Climate-Driven Heat Risks to Maternal and Fetal Health

Importance

In the current era of climate change, extreme heat exposure poses escalating threats to maternal-fetal health. Despite the expansive scale of extreme heat exposure worldwide, dramatized by the record-breaking global ocean and atmospheric temperatures throughout 2023 and into 2024, the extent of the threat posed by heat is underestimated and underappreciated. Unlike the physical destruction wrought by climate-driven events like hurricanes and wildfires, heat exposure does not cause severe damage to the built environment. Yet, in most years, heat has been the deadliest hazard in the United States.

Objectives

This expert review aims to illuminate how climate-related heat affects maternal-fetal health and exacerbates health inequities. It will also discuss current knowledge gaps and underscore the crucial role that obstetric providers play in safeguarding pregnant persons from exposure to hazardous heat and increasing patient awareness of climate-related heat.

Evidence Acquisition

Evidence for this review was primarily acquired through a comprehensive search of PubMed-indexed articles using MeSH terms and text words to search for concepts related to "climate change," "heat," "obstetrics," "pregnancy," "heat stress disorders," and their synonyms.

Results

Extreme heat exposure threatens the health and well-being of pregnant persons and elevates the likelihood of poor birth outcomes like preterm birth, fetal demise, and stillbirth, among other pregnancy complications. Extreme heat exposure also increases the risk of dehydration, heat exhaustion, heat stroke, and gestational hypertension for pregnant persons.

Conclusions and Relevance

Ultimately, obstetric professionals are essential to improving the care of pregnant persons at increased risk from salient climate-related heat exposure.

Reviewing the Impacts of Natural and Technological Disasters on the End-Stage Kidney Disease Community

The impact and severity of natural disasters and hazards have been increasing in the United States and throughout the world. With our mounting reliance and dependence on technology in our industrialized society, technological disasters also have become more commonplace. Although disasters may occur with little to no warning, these risks are felt to be acceptable despite their ability to impact large populations. Natural and technological disasters disproportionately affect vulnerable populations, including those with end-stage kidney disease (ESKD). The impact of natural and technological disasters on the ESKD community has been closely examined via numerous case studies and through the lens of particular disasters, but there is a paucity of data exploring the impacts of natural and technological disasters on the ESKD community by disaster type. A comprehensive literature search was performed using PubMed and Google Scholar, and relevant articles pertaining to the impacts of natural and technological disasters on the ESKD community were reviewed. More than 50 studies were reviewed in total. This review aimed to identify common patterns and trends observed in the impacts of different disaster types on the ESKD community to better prepare patients and their providers before the next disaster strikes.

Hurricanes and Health Equity: A Review of Structural Determinants of Vulnerability for Climate and Health Research

PURPOSE OF REVIEW

Understanding hurricane vulnerability is crucial for targeting and identifying climate adaptation measures. However, vulnerability assessments often focus on proximal factors, which may obscure underlying drivers of health inequities. We sought to describe the literature characterizing hurricane vulnerability in the U.S., from 2000 to 2022. We abstracted the approaches and factors in each hurricane vulnerability assessment study, and developed a conceptual framework to guide data collection on structural determinants of climate vulnerability.

RECENT FINDINGS

The review included a total of 121 studies. The majority pre-specified vulnerable populations, while 40% empirically derived vulnerability. Downstream factors pertaining to demographics, spatial analysis, and health status were most commonly used to assess vulnerability to hurricanes. Only five studies reported structural vulnerabilities, including racism, governance, institutions, and infrastructure deficiencies, which form the basis of our conceptual framework. Most hurricane vulnerability studies do not consider upstream factors of health inequities. We developed a conceptual framework and provided example data measures for structural determinants to incorporate into climate and health research, facilitating the development of more effective interventions to address root causes.

Designing Health Recommender Systems to Promote Health Equity: A Socioecological Perspective

Health recommender systems (HRS) have the capability to improve human-centered care and prevention by personalizing content, such as health interventions or health information. HRS, an emerging and developing field, can play a unique role in the digital health field as they can offer relevant recommendations, not only based on what users themselves prefer and may be receptive to, but also using data about wider spheres of influence over human behavior, including peers, families, communities, and societies. We identify and discuss how HRS could play a unique role in decreasing health inequities. We use the socioecological model, which provides representations of how multiple, nested levels of influence (eg, community, institutional, and policy factors) interact to shape individual health. This perspective helps illustrate how HRS could address not just individual health factors but also the structural barriers-such as access to health care, social support, and access to healthy food-that shape health outcomes at various levels. Based on this analysis, we then discuss the challenges and future research priorities. We find that despite the potential for targeting more complex systemic challenges to obtaining good health, current HRS are still focused on individual health behaviors, often do not integrate the lived experiences of users in the design, and have had limited reach and effectiveness for individuals from low socioeconomic status and racial or ethnic minoritized backgrounds. In this viewpoint, we argue that a new design paradigm is necessary in which HRS focus on incorporating structural barriers to good health in addition to user preferences. HRS should be designed with an emphasis on health systems, which also includes incorporating decolonial perspectives of well-being that challenge prevailing medical models. Furthermore, potential lies in evaluating the health equity effects of HRS and leveraging collected data to influence policy. With changes in practices and with an intentional equity focus, HRS could play a crucial role in health promotion and decreasing health inequities.

Interrogating Healthy Community Discourse in Municipal Policies: Priorities of a Medium-Sized CMA in Ontario, Canada

The World Health Organization's Healthy Cities movement recommends action on the determinants of health and health equity. While economic and ecological circumstances have been studied with respect to health outcomes, research shows that the relationship between these broad determinants and population health is not always clear. Municipal governments, whose relative proximity to individuals means that they are optimally situated to address local health concerns, can demonstrate political will for healthy communities by developing health community policies. Therefore, the aim of this study is to interrogate how the idea of a 'healthy community' has been conceptualized by municipal governments in order to inform the future uptake of the concept. This study uses a post-structural policy analysis to examine government discourse on healthy communities in a medium-sized census metropolitan area (CMA) in Ontario, Canada. The findings highlight economic growth and ecological sustainability as priorities for fostering a healthy community. With emphasis on long-standing issues linking health outcomes to broader societal conditions, this study calls on municipal governments to explicitly consider the health impacts of healthy community strategies and adoption of a Health-in-All-Policies (HiAP) approach.

Exploring Intersections Between Trauma and Discrimination in Youth of Color Seeking Mental Health Services

OBJECTIVE

The purpose of this study is to explore the intersection between trauma and discrimination among Black and Latino/a/x youth seeking treatment. Specifically, we examine the following: (1) the frequency of various everyday discrimination experiences, averaged across the sample and disaggregated by demographic characteristics; (2) unique associations between exposure to potentially traumatic events (PTEs) and everyday discrimination experiences; and (3) unique associations between everyday discrimination experiences and specific posttraumatic stress symptoms while accounting for demographic characteristics and PTEs.

METHOD

Participants were 573 Black (54.8%) and non-Black Latino/a/x youth (10-18 years of age, 55.8% female, 25.7% first- or second-generation immigrant) who were treatment-seeking and had exposure at least one traumatic event.

RESULTS

Two-thirds of trauma-exposed youth reported having experienced discrimination, with the most common experience being treated as not smart (46%), followed by being treated with less courtesy or respect (40%). Rates of discrimination varied by intersecting demographic characteristics in nuanced ways. Among 11 PTEs, exposure to a natural disaster, experiencing community violence, and witnessing community violence were each positively associated with overall everyday discrimination scores and specific discriminatory encounters. Everyday discrimination experiences were positively associated with posttraumatic stress symptoms after accounting for demographic characteristics and exposure to PTEs.

CONCLUSION

Findings provide important context for understanding experiences of everyday discrimination in Black and Latino/a/x youth seeking mental health services for trauma. Findings further highlight variability in the types of discrimination youth with different intersecting identities experience, the high rates of co-occurrence between discrimination and other traumatic events, and unique associations between specific discrimination experiences and posttraumatic stress reactions.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper received support from a program designed to increase minority representation in science.

Application of the Lasso regularisation technique in mitigating overfitting in air quality prediction models

As a significant global concern, air pollution triggers enormous challenges in public health and ecological sustainability, necessitating the development of precise algorithms to forecast and mitigate its impacts, which has led to the development of many machine learning (ML)-based models for predicting air quality. Meanwhile, overfitting is a prevalent issue with ML algorithms that decreases their efficacy and generalizability. The present investigation, using an extensive collection of data from 16 sensors in Tehran, Iran, from 2013 to 2023, focuses on applying the Least Absolute Shrinkage and Selection Operator (Lasso) regularisation technique to enhance the forecasting precision of ambient air pollutants concentration models, including particulate matter (PM2.5 and PM10), CO, NO2, SO2, and O3 while decreasing overfitting. The outputs were compared using the R-squared (R2), mean absolute error (MAE), mean square error (MSE), root mean square error (RMSE), and normalised mean square error (NMSE) indices. Despite the preliminary findings revealing that Lasso dramatically enhances model reliability by decreasing overfitting and determining key attributes, the model's performance in predicting gaseous pollutants against PM remained unsatisfactory (R2PM2.5 = 0.80, R2PM10 = 0.75, R2CO = 0.45, R2NO2 = 0.55, R2SO2 = 0.65, and R2O3 = 0.35). The minimal degree of missing data presumably explained the strong performance of the PM model, while the high dynamism of gases and their chemical interactions, in conjunction with the inherent characteristics of the model, were the primary factors contributing to the poor performance of the model. Simultaneously, the successful implementation of the Lasso regularisation approach in mitigating overfitting and selecting more important features makes it highly suggested for application in air quality forecasting models.

Wildfire Smoke Exposure and Incident Dementia

Importance

Long-term exposure to total fine particulate matter (PM2.5) is a recognized dementia risk factor, but less is known about wildfire-generated PM2.5, an increasingly common PM2.5 source.

Objective

To assess the association between long-term wildfire and nonwildfire PM2.5 exposure and risk of incident dementia.

Design, Setting, and Participants

This open cohort study was conducted using January 2008 to December 2019 electronic health record (EHR) data among members of Kaiser Permanente Southern California (KPSC), which serves 4.7 million people across 10 California counties. KPSC members aged 60 years or older were eligible for inclusion. Members were excluded if they did not meet eligibility criteria, if they had a dementia diagnosis before cohort entry, or if EHR data lacked address information. Data analysis was conducted from May 2023 to May 2024.

Exposures

Three-year rolling mean wildfire and nonwildfire PM2.5 in member census tracts from January 2006 to December 2019, updated quarterly and estimated via monitoring and remote-sensing data and statistical techniques.

Main Outcome and Measures

The primary outcome was incident dementia, identified using diagnostic codes in the EHR. Odds of dementia diagnoses associated with 3-year mean wildfire and nonwildfire PM2.5 exposure were estimated using a discrete-time approach with pooled logistic regression. Models adjusted for age, sex, race and ethnicity (considered as a social construct rather than as a biological determinant), marital status, smoking status, calendar year, and census tract-level poverty and population density. Stratified models assessed effect measure modification by age, sex, race and ethnicity, and census tract-level poverty.

Results

Among 1.64 million KPSC members aged 60 years or older during the study period, 1 223 107 members were eligible for inclusion in this study. The study population consisted of 644 766 female members (53.0%). In total, 319 521 members identified as Hispanic (26.0%), 601 334 members identified as non-Hispanic White (49.0%), and 80 993 members received a dementia diagnosis during follow-up (6.6%). In adjusted models, a 1-μg/m3 increase in the 3-year mean of wildfire PM2.5 exposure was associated with an 18% increase in the odds of dementia diagnosis (odds ratio [OR], 1.18; 95% CI, 1.03-1.34). In comparison, a 1-μg/m3 increase in nonwildfire PM2.5 exposure was associated with a 1% increase (OR, 1.01; 95% CI, 1.01-1.02). For wildfire PM2.5 exposure, associations were stronger among members less than 75 years old upon cohort entry, members from racially minoritized subgroups, and those living in high-poverty vs low-poverty census tracts.

Conclusions and Relevance

In this cohort study, after adjusting for measured confounders, long-term exposure to wildfire and nonwildfire PM2.5 over a 3-year period was associated with dementia diagnoses. As the climate changes, interventions focused on reducing wildfire PM2.5 exposure may reduce dementia diagnoses and related inequities.

Understanding mental health challenges and associated risk factors of post-natural disasters in Bangladesh: a systematic review

Background and objectives

Natural disasters are harmful occurrences caused by the Earth's geological and meteorological processes. Bangladesh is recognized as one of the country's most vulnerable to natural disasters. Therefore, the people of Bangladesh remain at high risk of natural disasters. However, no study has been conducted in Bangladesh to provide an overall perspective on mental health issues that arise after natural disasters. Thus, this systematic review aims to identify all mental health issues and related risk factors brought on by natural disasters in Bangladesh.

Study design

Systematic review.

Methods

Between April to May 2024, a systematic search was conducted across many databases, including PubMed, following the PRISMA guideline. Ultimately, 17 publications were included in this study.

Results

The findings reveal that depression, anxiety, stress, suicidal ideation, post-traumatic stress disorder, major depressive disorder, generalized anxiety disorder and sleep disturbances are found as major risk factors for natural disasters. Prevalence of depression, anxiety and, stress, suicidal ideation ranges from 16.3% to 92.71%, 6% to 92.19%, 32.41% to 58%, 10.9% to 57.5% among people as consequences of natural disasters like heatwaves, cyclones, flood, river bank erosion etc. There are some associated risk factors which provoke prominent mental health problems, including (i) Demographic factors (age, gender, marital status, number of children, lower education, living location, living infrastructure, family conflicts, family member death, land for cultivation, loss of domestic animals), (ii) socio-economic factors (environmental settings, social support, disaster warning system, displacement, food crisis, financial support, income loss, vulnerable livelihoods) (iii) behavior and health-related factors (behavior pattern, physical injury during natural disaster, physical disability), (iv) other factors (increased temperature, living together, lower social class). People affected by natural disasters are often viewed in terms of their physical damage, while their mental health is always ignored.

Conclusion

Calculative measures are needed to create an overall picture of the effect of natural disasters on people's mental health in Bangladesh. Therefore, the government needs to consider establishing potential measures to lessen the impact of natural disasters on people's mental health.

Multilateral funding for health adaptation and the health co-benefits of climate mitigation: An observational study

BACKGROUND

The health impacts of climate change have been increasingly recognised for the past years. However, it remains unclear how this has translated into funding for health adaptation and health co-benefits of climate mitigation.

METHODS

We analysed the projects funded by the Green Climate Fund (GCF) between 2021 and 2023 and the Adaptation Fund between 2019 and 2024 to estimate the amount of funding provided for health adaptation and the health co-benefits of climate mitigation. Based on the Notre Dame Global Adaptation Index (ND-GAIN), we estimated adaptation vulnerability and readiness for each country and investigated the association between this index and the total adaptation funding received by each country.

FINDINGS

Between 2021 and 2023, 85 projects were funded by the GCF, of which 37 were adaptation, 32 cross-cutting, and 16 mitigation projects. The funds provided by the GCF contributed US$764 million to health adaptation (US$178 million in 2021 to US$422 million in 2023). There was no association between the amount of funding provided by the GCF towards adaptation and the estimated vulnerability, resilience, and combined adaptation index (ND-GAIN) at country level. Among the 48 mitigation and cross-cutting projects, 15 did not mention health, 13 mislabelled health co-benefits, 11 identified specific health co-benefits, and 9 correctly identified and measured health co-benefits as outcomes. The main health co-benefits were reduction in the health impact of air pollution, improved nutrition, and reduction in traffic casualties. There were 15 active projects on the Adaptation Fund website, amounting to a total of US$51,944,915. Seven of the projects mentioned health benefits but only one explicitly measured health adaptation indicators as outcomes.

INTERPRETATION

Funding for health adaptation and health co-benefits of mitigation provided by the two main multilateral adaptation funds has been increasing over the recent years. However, it remains insufficient and does not seem to be targeting the countries facing the greatest impacts of climate change.

Ultrasound-assisted extraction and antioxidant activity of polysaccharides from Tenebrio molitor

Tenebrio molitor, which is rich in various nutrients, and its polysaccharides, as significant bioactive substances, exhibit strong antioxidant effects. This study utilized defatted T. molitor as raw material and employed an ultrasound-assisted extraction method. The factors considered include extraction temperature, time, ultrasound power, and liquid-to-feed ratio, with the yield of T. molitor polysaccharides as the response value. Based on single-factor experiments and response surface methodology, the optimal extraction parameters for T. molitor polysaccharides were determined. Following purification, protein removal, and dialysis to eliminate impurities, the structure of the extracted polysaccharides was preliminarily investigated using infrared spectroscopy. Their antioxidant activities were explored by measuring their DPPH·, OH·, and ABTS+· radical scavenging abilities and Fe3+ reducing power. The results indicated that the optimal conditions for ultrasound-assisted extraction were an extraction temperature of 75 °C, an extraction time of 150 min, an ultrasound power of 270 W, and a liquid-to-feed ratio of 15:1 mL/g, yielding a polysaccharide extraction rate of 9.513%. Infrared spectroscopy analysis revealed the presence of pyranose sugars with main functional groups including C-O, C=O, and O-H. Antioxidant activity tests showed that within a certain concentration range, the higher the polysaccharide concentration, the stronger its radical scavenging abilities. Compared with Vitamin C(Vc), the polysaccharides had stronger scavenging abilities for DPPH· and OH·, some scavenging ability for ABTS+·, and Fe3+ reduction ability, and corresponding to IC50 values of 0.9625, 9.1909, and 235.69 mg/mL respectively. The Fe3+ reducing power reached a maximum absorbance of 0.38899 at a concentration of 1.6 mg/mL. T. molitor polysaccharides demonstrate promising antioxidant activity and potential as functional ingredients in food, health products, and pharmaceuticals, providing new technical references for the development and utilization of T. molitor resources.

Enhancing primary healthcare nurses' preparedness for climate-induced extreme weather events

BACKGROUND

Climate Change is causing frequent and sever extreme weather events globally, impacting human health and well-being. Primary healthcare (PHC) nurses' are at the forefront of addressing these challenges and must be prepared.

PURPOSE

This scoping revieww explored literature on the preparedness of the PHC nursing workforce for extreme weather events and identify gaps in knowledge and practice.

METHODS

Using Arksey and O'Malley's framework, a comprehensive search was conducted across PubMed, Scopus, CINHAL, Web of Sciences, and ProQuest, on studies from 2014-2024, addressing PHC nurses' preparedness.

DISCUSSION

Nine studies were identified and highlighted a need for preparedness training and facility-based preparedness plans. Key themes included prioritizing regional networks, clinical leadership, service delivery, health information, health workforce, medical products and technologies, and financing.

CONCLUSION

Strengthening PHC nurses' resilience against extreme weather requires targeted professional development, mental health support, comprehensive planning, and collaborative efforts. Future strategies should enhance PHC nurses' capacity through training, support, and policy development.

Exploring ownership of change and health equity implications in neighborhood change processes: A community-led approach to enhancing just climate resilience in Everett, MA

Traditional planning processes have perpetuated the exclusion of historically marginalized communities, imposing vulnerability to climate (health) crises. We investigate how ownership of change fosters equitable climate resilience and community well-being through participatory action research. Our study highlights the detrimental effects of climate gentrification on community advocacy for climate security and health, negatively impacting well-being. We identify three key processes of ownership of change: ownership of social identity, development and decision-making processes, and knowledge. These approaches emphasize community-led solutions to counter climate health challenges and underscore the interdependence of social and environmental factors in mental health outcomes in climate-stressed communities.

The Association of Socio-Environmental Inequality and Outcomes Among Patients Undergoing Major Surgery

INTRODUCTION

Environmental hazards may influence health outcomes and be a driver of health inequalities. We sought to characterize the extent to which social-environmental inequalities were associated with surgical outcomes following a complex operation.

METHODS

In this cross-sectional study, patients who underwent abdominal aortic aneurysm repair, coronary artery bypass grafting, colectomy, pneumonectomy, or pancreatectomy between 2016 and 2021 were identified from Medicare claims data. Patient data were linked with social-environmental data sourced from Centers for Disease Control and Agency for Toxic Substances and Disease Registry data based on county of residence. The Environmental Justice Index social-environmental ranking (SER) was used as a measure of environmental injustice. Multivariable regression analysis was performed to assess the relationship between SER and surgical outcomes.

RESULTS

Among 1,052,040 Medicare beneficiaries, 346,410 (32.9%) individuals lived in counties with low SER, while 357,564 (33.9%) lived in counties with high SER. Patients experiencing greater social-environmental injustice were less likely to achieve textbook outcome (odds ratio 0.95, 95% confidence interval 0.94-0.96, P < 0.001) and to be discharged to an intermediate care facility or home with a health agency (odds ratio 0.97, 95% confidence interval 0.96-0.98, P < 0.001).

CONCLUSIONS

Cumulative social and environmental inequalities, as captured by the Environmental Justice Index SER, were associated with postoperative outcomes among Medicare beneficiaries undergoing a range of surgical procedures. Policy makers should focus on environmental, as well as socioeconomic injustice to address preventable health disparities.

Nursing students' conceptualization of environmental problems: a descriptive cross-sectional study

BACKGROUND

The significant challenges of the twenty-first century revolve around environmental issues. Knowing individuals' environmental attitudes and what they see as environmental problems is crucial to mobilizing them to action. Nurses hold a significant responsibility in addressing and combating environmental challenges.

RESEARCH AIM

This study had two objectives: understanding how nursing students classify environmental issues and examining the effects of gender, economic status, school district, family environmental awareness, and perception of global responsibility on their conceptualization of environmental issues.

DESIGN

A descriptive cross-sectional study using a questionnaire.

SETTING AND PARTICIPANTS

The sample consisted of 1466 nursing students from four faculties of two public universities in Turkiye. The study was conducted between January and April 2023.

METHODS

Data were collected using a form that included 19 issues ranging from ecological problems to social problems related to the environment, as well as the Global Social Responsibility Scale (GSRS). The data were analyzed using explanatory factor analysis, multiple regression, and mediator analysis.

RESULTS

Participants classified the environmental issues as eco-social-oriented and human-oriented. First-year students (B = -0.201), male students (B = -0.263), those studying in rural schools (B = -0.123), and those who rarely discuss environmental issues in the family (B = -0.197) describe the problems in the eco-social oriented dimension as less "environmental." The increase in the action-oriented responsibility (B = 0.014) and ecological responsibility (B = 0.077) scores of The Global Social Responsibility Scale leads to an increase in recognizing the problems in this area as environmental issues. Similarly, first-year students (B = -0.340), male students (B = -0.293), and those who rarely discussed environmental issues in the family (B = -0.243) led to a decrease in recognizing problems as environmental in the human-oriented issues dimension. In contrast, poor socioeconomic perception (B = 0.245), negative perception of the future (B = 0.145), and increased action-oriented responsibility (B = 0.024) and ecological responsibility (B = 0.042) led to an increase in recognition of human-oriented issues. The increase in the national responsibility score decreased the score of environmental assessment of the problems in this area (B = -0.017). In addition, the perception of global responsibility partially mediates between students' sociodemographic characteristics and environmental issues recognition scores in both sub-dimensions.

CONCLUSION

This study presents results that point to individual differences among nursing students in addressing environmental issues, reveal the impact of family on these differences, and finally show the importance of curricula to increase students' global social responsibility during their education.

Examining air pollution exposure dynamics in disadvantaged communities through high-resolution mapping

This study bridges gaps in air pollution research by examining exposure dynamics in disadvantaged communities. Using cutting-edge machine learning and massive data processing, we produced high-resolution (100 meters) daily air pollution maps for nitrogen dioxide (NO2), fine particulate matter (PM2.5), and ozone (O3) across California for 2012-2019. Our findings revealed opposite spatial patterns of NO2 and PM2.5 to that of O3. We also identified consistent, higher pollutant exposure for disadvantaged communities from 2012 to 2019, although the most disadvantaged communities saw the largest NO2 and PM2.5 reductions and the advantaged neighborhoods experienced greatest rising O3 concentrations. Further, day-to-day exposure variations decreased for NO2 and O3. The disparity in NO2 exposure decreased, while it persisted for O3. In addition, PM2.5 showed increased day-to-day variations across all communities due to the increase in wildfire frequency and intensity, particularly affecting advantaged suburban and rural communities.

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.

Identifying Holistic Nursing Research Priorities for 2023-2026

The primary goal of holistic nursing research is to develop and expand the knowledge base of holism and healing for nursing praxis. This article provides an overview of the process used to identify the research priorities for holistic nursing research over the next 3 to 5 years. A mixed method design using Appreciative Inquiry and surveys revealed five research priorities and the holistic philosophical foundation for these priorities. Additionally, new challenges in the environment, person, health, and nursing will undoubtedly emerge, requiring nurses to discern the research needs beyond 2026. This work seeks to inspire holistic nurses to consider research related to the American Holistic Nurses Association's five key research priorities.

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.

Climate Events, Displacement, and Mental Health-Uprooted

This Viewpoint discusses the implications of climate event–related disasters and displacement as well as strategies for mitigating their mental health effects.

Exploring apple pectic polysaccharides: Extraction, characterization, and biological activities - A comprehensive review

Apple (Malus domestica) is a popular and ancient fruit of the Myrtaceae family. Apple fruit is well-known for its great nutritional and phytochemical content consisted of beneficial compounds such as polyphenols, polysaccharides, sterols, and organic acids. Polysaccharides extracted from different parts of the apple fruit, including the peel, pomace, or the whole fruit, have been extensively studied. Researchers have investigated the structural characteristics of these polysaccharides, such as molecular weight, type of monosaccharide unit, type of linkage and its position and arrangement. Besides this, functional properties and physicochemical and of apple polysaccharides have also been studied, along with the effects of extraction procedures, storage, and processing on cell wall polysaccharides. Various extraction techniques, including hot water extraction, enzymatic extraction, and solvent-assisted extraction, have been studied. From the findings, it was evident that apple polysaccharides are mainly composed of (1 → 3), (1 → 6): α-β-glycosidic linkage. Moreover, the apple polysaccharides were demonstrated to exhibit antioxidant, hepatoprotective, anti-cancer, hypoilipidemic, and enzyme inhibitory properties in vitro and in vivo. The potential applications of apple polysaccharides in the food, cosmetic, pharmaceutical, nutraceutical industries have also been explored in the present review. Overall, the research on apple polysaccharides highlights their significant potential as a source of biologically active compounds with various health benefits and practical applications.

Front-Line Insights Into the Social Determinants of Health in Housing Instability: A Multi-Province Study

INTRODUCTION

Individuals experiencing housing instability face significant health inequities. Addressing housing instability requires an understanding of the factors that contribute to these inequities-a responsibility that has been assumed by community-based organizations. Interviewing individuals from 3 Canadian provinces, the present study aimed to examine the perspectives of individuals from front-line services of the social determinants of health (SDoH) needs of individuals experiencing housing instability.

METHODS

As part of a larger knowledge translation study, we conducted 8 semi-structured interviews with individuals from front-line services (eg, shelter workers and shelter mental health nurses) in Canada (Nova Scotia, Saskatchewan, and Alberta) and used thematic analysis to identify predominant unmet SDoH needs.

RESULTS

Individuals from front-line services discussed the roles of many SDoH that may perpetuate housing instability in their clients. These included: (1) limited social supports; (2) poor access to health services; (3) poor opportunities for income and employment; (4) lack of transportation; (5) gender-based discrimination; (6) race-based discrimination; and (7) limited access to education and limited literacy skills.

CONCLUSION

This study reveals how front-line service providers observe SDoH factors contributing to housing instability and create barriers to accessing support services. They advocate for a multi-system approach to addressing intersecting SDoH factors to validate clients' experiences and help them achieve stable housing. Additionally, more research and consultation with front-line providers are necessary to understand and overcome systemic barriers to stable housing.

Predicting Unmet Healthcare Needs in Post-Disaster: A Machine Learning Approach

Unmet healthcare needs in the aftermath of disasters can significantly impede recovery efforts and exacerbate health disparities among the affected communities. This study aims to assess and predict such needs, develop an accurate predictive model, and identify the key influencing factors. Data from the 2017 Long-term Survey on the Change of Life of Disaster Victims in South Korea were analyzed using machine learning techniques, including logistic regression, C5.0 tree-based model, and random forest. The features were selected based on Andersen's health behavior model and disaster-related factors. Among 1659 participants, 31.5% experienced unmet healthcare needs after a disaster. The random forest algorithm exhibited the best performance in terms of precision, accuracy, Under the Receiver Operating Characteristic (AUC-ROC), and F-1 scores. Subjective health status, disaster-related diseases or injuries, and residential area have emerged as crucial factors predicting unmet healthcare needs. These findings emphasize the vulnerability of disaster-affected populations and highlight the value of machine learning in post-disaster management policies for decision-making.

Environmental Exposure Disparities and Neurodevelopmental Risk: a Review

PURPOSE OF REVIEW

Neurotoxicant exposures are of particular concern in historically marginalized communities. Often a consequence of structural racism, low-income minoritized populations experience a disproportionate burden of hazardous exposures through proximity to industrial facilities, high traffic roads, and suboptimal housing. Here, we summarize reports on exposures and neurodevelopment focused on differences by education, income, race/ethnicity, or immigration status from 2015 to 2022, discuss the importance of such investigations in overburdened communities, and recommend areas for future research.

RECENT FINDINGS

We found 20 studies that investigated exposure disparities and neurodevelopment in children. Most were conducted in the USA, and many focused on air pollution, followed by metal exposures and water contamination. Although several studies showed differences in exposure-outcome associations by income and education, many examining differences by race/ethnicity did not report notable disparities between groups. However, measures of individual race and ethnicity are not reliable measures of discrimination experienced as a consequence of structural racism. Our review supports scientific evidence that the reduction of individual and widespread municipal exposures will improve child development and overall public health. Identified research gaps include the use of better indicators of economic status and structural racism, evaluations of effect modification and attributable fraction of outcomes by these factors, and considerations of multidimensional neighborhood factors that could be protective against environmental insults. Considering that vulnerable populations have disparities in access to and quality of care, greater burden of exposure, and fewer resources to incur associated expenses, such populations should be prioritized.

Sustainability and Equity in Urban Development (S&EUD): A Content Analysis of "Bright Spots" from the Accelerating City Equity (ACE) Project

Sustainable and equitable urban development (S&EUD) is vital to promote healthy lives and well-being for all ages. Recognizing equity as core to urban development is essential to ensure that cities are inclusive, safe, resilient, and sustainable. The aim of this study was to identify and assess the elements of equity and sustainability in exemplary bright spots using the ACE Framework and the United Nations' 5 Ps of Sustainable Development. A content analysis process was performed to identify initial case studies, obtain bright spot information, and select final case studies. The exemplary bright spots selected were assessed for drivers of equity and the five pillars of sustainability. Results showed that equity and sustainability have become key considerations in urban development work. Numerous effective strategies and outcomes identified in the exemplary bright spots could be replicated in other contexts.

Agreement in extreme precipitation exposure assessment is modified by race and social vulnerability

Epidemiologic investigations of extreme precipitation events (EPEs) often rely on observations from the nearest weather station to represent individuals' exposures, and due to structural factors that determine the siting of weather stations, levels of measurement error and misclassification bias may differ by race, class, and other measures of social vulnerability. Gridded climate datasets provide higher spatial resolution that may improve measurement error and misclassification bias. However, similarities in the ability to identify EPEs among these types of datasets have not been explored. In this study, we characterize the overall and temporal patterns of agreement among three commonly used meteorological data sources in their identification of EPEs in all census tracts and counties in the conterminous United States over the 1991-2020 U.S. Climate Normals period and evaluate the association between sociodemographic characteristics with agreement in EPE identification. Daily precipitation measurements from weather stations in the Global Historical Climatology Network (GHCN) and gridded precipitation estimates from the Parameter-elevation Relationships on Independent Slopes Model (PRISM) and the North American Land Data Assimilation System (NLDAS) were compared in their ability to identify EPEs defined as the top 1% of precipitation events or daily precipitation >1 inch. Agreement among these datasets is fair to moderate from 1991 to 2020. There are spatial and temporal differences in the levels of agreement between ground stations and gridded climate datasets in their detection of EPEs in the United States from 1991 to 2020. Spatial variation in agreement is most strongly related to a location's proximity to the nearest ground station, with areas furthest from a ground station demonstrating the lowest levels of agreement. These areas have lower socioeconomic status, a higher proportion of Native American population, and higher social vulnerability index scores. The addition of ground stations in these areas may increase agreement, and future studies intending to use these or similar data sources should be aware of the limitations, biases, and potential for differential misclassification of exposure to EPEs. Most importantly, vulnerable populations should be engaged to determine their priorities for enhanced surveillance of climate-based threats so that community-identified needs are met by any future improvements in data quality.

The 2021 Texas Power Crisis: distribution, duration, and disparities

BACKGROUND

Precipitated by an unusual winter storm, the 2021 Texas Power Crisis lasted February 10 to 27 leaving millions of customers without power. Such large-scale outages can have severe health consequences, especially among vulnerable subpopulations such as those reliant on electricity to power medical equipment, but limited studies have evaluated sociodemographic disparities associated with outages.

OBJECTIVE

To characterize the 2021 Texas Power Crisis in relation to distribution, duration, preparedness, and issues of environmental justice.

METHODS

We used hourly Texas-wide county-level power outage data to estimate geographic clustering and association between outage exposure (distribution and duration) and six measures of racial, social, political, and/or medical vulnerability: Black and Hispanic populations, the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), Medicare electricity-dependent durable medical equipment (DME) usage, nursing homes, and hospitals. To examine individual-level experience and preparedness, we used a preexisting and non-representative internet survey.

RESULTS

At the peak of the Texas Power Crisis, nearly 1/3 of customers statewide (N = 4,011,776 households/businesses) lost power. We identified multiple counties that faced a dual burden of racial/social/medical vulnerability and power outage exposure, after accounting for multiple comparisons. County-level spatial analyses indicated that counties where more Hispanic residents resided tended to endure more severe outages (OR = 1.16, 95% CI: 1.02, 1.40). We did not observe socioeconomic or medical disparities. With individual-level survey data among 1038 respondents, we found that Black respondents were more likely to report outages lasting 24+ hours and that younger individuals and those with lower educational attainment were less likely to be prepared for outages.

SIGNIFICANCE

Power outages can be deadly, and medically vulnerable, socioeconomically vulnerable, and marginalized groups may be disproportionately impacted or less prepared. Climate and energy policy must equitably address power outages, future grid improvements, and disaster preparedness and management.

Impact of the 2021 north american winter storms on children with epilepsy

Purpose

In February 2021 a series of winter storms caused power outages for nearly 10 million people in the United States, Northern Mexico and Canada. In Texas, the storms caused the worst energy infrastructure failure in state history, leading to shortages of water, food and heat for nearly a week. Impacts on health and well-being from natural disasters are greater in vulnerable populations such as individuals with chronic illnesses, for example due to supply chain disruptions. We aimed to determine the impact of the winter storm on our patient population of children with epilepsy (CWE).

Methods

We conducted a survey of families with CWE that are being followed at Dell Children's Medical Center in Austin, Texas.

Results

Of the 101 families who completed the survey, 62% were negatively affected by the storm. Twenty-five percent had to refill antiseizure medications during the week of disruptions, and of those needing refills, 68% had difficulties obtaining the medications, leading to nine patients-or 36% of those needing a refill-running out of medications and two emergency room visits because of seizures and lack of medications.

Conclusions

Our results demonstrate that close to 10% of all patients included in the survey completely ran out of antiseizure medications, and many more were affected by lack of water, heat, power and food. This infrastructure failure emphasizes the need for adequate disaster preparation for vulnerable populations such as children with epilepsy for the future.

Vulnerable, Resilient, or Both? A Qualitative Study of Adaptation Resources and Behaviors to Heat Waves and Health Outcomes of Low-Income Residents of Urban Heat Islands

Little is known of how low-income residents of urban heat islands engage their knowledge, attitudes, behaviors, and resources to mitigate the health impacts of heat waves. In this qualitative study, we conducted semi-structured interviews with 40 adults in two such neighborhoods in Los Angeles California to explore their adaptation resources and behaviors, the impacts of heat waves on physical and mental health, and threat assessments of future heat waves. Eighty percent of participants received advanced warning of heat waves from television news and social media. The most common resource was air conditioning (AC) units or fans. However, one-third of participants lacked AC, and many of those with AC engaged in limited use due primarily to the high cost of electricity. Adaptation behaviors include staying hydrated, remaining indoors or going to cooler locations, reducing energy usage, and consuming certain foods and drinks. Most of the participants reported some physical or mental health problem or symptom during heat waves, suggesting vulnerability to heat waves. Almost all participants asserted that heat waves were likely to increase in frequency and intensity with adverse health effects for vulnerable populations. Despite limited resources, low-income residents of urban heat islands utilize a wide range of behaviors to minimize the severity of health impacts, suggesting they are both vulnerable and resilient to heat waves.

Systematic review of climate change effects on reproductive health

Climate change is a major risk factor for overall health, including reproductive health, and well-being. Increasing temperatures, due mostly to increased greenhouse gases trapping excess heat in the atmosphere, result in erratic weather patterns, wildfires, displacement of large communities, and stagnant water resulting in vector-borne diseases that, together, have set the stage for new and devastating health threats across the globe. These conditions disproportionately affect disadvantaged and vulnerable populations, including women, pregnant persons, young children, the elderly, and the disabled. This review reports on the evidence for the adverse impacts of air pollution, wildfires, heat stress, floods, toxic chemicals, and vector-borne diseases on male and female fertility, the developing fetus, and obstetric outcomes. Reproductive health care providers are uniquely positioned and have an unprecedented opportunity to educate patients and policy makers about mitigating the impact of climate change to assure reproductive health in this and future generations.