Climate change: the public health response

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.

Scoping review on assessing climate-sensitive health risks

BACKGROUND

Climate change is making the existing health problems worse and also introducing new health problem and therefore calls for a wider evaluation of climate sensitive global diseases. The review sought to assess and collate quantitative and qualitative evidence on the effects of climate change on global health, more specifically, infectious and respiratory diseases, the impacts of extreme weather events as well as the implications for mental health with the view of establishing appropriate sustainable and resilience public health measures and policies.

METHODOLOGY

A scoping review of observational studies carried out between the years 2000 and 2024, synthesized information on climate-sensitive health outcomes: infectious diseases, severe weather events, and mental illnesses. This analysis was based on data from PubMed, Scopus, Web of Science and Cochrane Library, where appropriate, utilizing meta-extraction and Meta-analysis techniques.

RESULTS

A total of 3077 studies were screened, and 96 articles were included for quantitative and qualitative analysis, highlighting the significant health risks posed by climate change. Key areas of concern identified include climate-sensitive infectious diseases, respiratory and cardiovascular conditions, food- and water-borne illnesses, and mental health effects. Rising temperatures and variable rainfall patterns increase the incidence of diseases like malaria (up to 50%) and dengue (8-10% per 1 °C rise). Extreme weather events, such as heatwaves and floods, contribute to a 30% rise in respiratory diseases and a 25% increase in cardiovascular conditions. Food- and water-borne illnesses are more prevalent in regions like Africa (30-40%) due to climate change. Additionally, climate change exacerbates mental health issues, leading to conditions like post-traumatic stress disorder (PTSD), anxiety, and depression.

CONCLUSION AND RECOMMENDATIONS

Climate change amplifies global public health risks, worsening diseases and creating new challenges. To address this, enhance machine learning climate sensitive disease surveillance, strengthen climate resilience health infrastructure, and integrate health into climate adaptation and mitigation strategies, promote sustainable agriculture, improve WASH infrastructure, and foster global collaboration.

Indicators from The Lancet Countdown on Health and Climate Change: Perspectives and Experience of City Leaders from 118 Cities

Rapid urbanization and escalating climate crises place cities at the critical juncture of environmental and public health action. Urban areas are home to more than half of the global population, contributing ~ 75% of global greenhouse gas emissions. Structured surveys were completed by 191 leaders in city governments and civil society from 118 cities in 52 countries (February-April 2024). Data aggregated to report one response per city. The survey utilized framework and indicators established by The 2023 Lancet Countdown on Health and Climate Change. (1) Health hazards, exposures, impacts: two-thirds of cities identify extreme heat, flooding, and air pollution of "high concern," with health impacts for residents. (2) Adaptation, planning, resilience for health: Although 60% of cities have climate resilience plans, only 22.9% of cities have plans that concurrently address climate and health. Essential resources, municipal systems, and cross-sector collaborations are limited. (3) Mitigation actions and health co-benefits: 90% of cities reported air pollution from multiple sources; only 38% monitor air quality. Energy, food, and transportation systems are sub-optimal to mitigate climate concerns. (4) Economics and finance: 92% of cities report climate change-related economic losses; they plan to increase investments though resources remain constrained. (5) Public and political engagement: City leaders report minimal knowledge sharing among media, national/local government, scientific community, business community, and residents. Results underscore urgency for action and highlight solutions, providing a roadmap for cities to enhance resilience, safeguard public health, and promote social equity.

Political economics in health and implications for neurosurgery diseases

The field of political economics in health has a significant and far-reaching impact on public health. It encompasses a diverse range of interconnected domains, including the economy, welfare, the environment, food and drug safety, pollution emissions, occupational safety, the quality of medical services, consumer rights, public health policy, healthcare policy, scientific research, and marketing management. In this review, we examine the global influence of political economics on health outcomes and delineate the impact of prevalent neurosurgical conditions on individual and collective healthcare resources. This review will discuss the effects of political-economic factors on the prevalence and treatment of neurosurgical diseases, including stroke, traumatic brain injury (TBI), intracerebral hemorrhage (ICH), and brain malignant tumors. Furthermore, the current challenges and future directions will be discussed. We intend this review to facilitate the exchange and integration of political economics, public health, and neurosurgery, provide a foundation for policy development, enhance the prevention, diagnosis, and treatment of neurosurgical diseases, and ultimately promote public health.

Resilience Informatics in Public Health: Qualitative Analysis of Conference Proceedings

BACKGROUND

In recent years, public health has confronted 2 formidable challenges: the devastating COVID-19 pandemic and the enduring threat of climate change. The convergence of these crises underscores the urgent need for resilient solutions. Resilience informatics (RI), an emerging discipline at the intersection of informatics and public health, leverages real-time data integration from health systems, environmental monitoring, and technological tools to develop adaptive responses to multifaceted crises. It offers promising avenues for mitigating and adapting to these challenges by proactively identifying vulnerabilities and fostering adaptive capacity in public health systems. Addressing critical questions regarding target audiences, privacy concerns, and scalability is paramount to fostering resilience in the face of evolving health threats.

OBJECTIVE

The University of Arizona held a workshop, titled Resilience Informatics in Public Health, in November 2023 to serve as a pivotal forum for advancing these discussions and catalyzing collaborative efforts within the field. This paper aims to present a qualitative thematic analysis of the findings from this workshop.

METHODS

A purposive sampling strategy was used to invite 40 experts by email from diverse fields, including public health, medicine, weather services, informatics, environmental science, and resilience, to participate in the workshop. The event featured presentations from key experts, followed by group discussions facilitated by experts. The attendees engaged in collaborative reflection and discussion on predetermined questions. Discussions were systematically recorded by University of Arizona students, and qualitative analysis was conducted. A detailed thematic analysis was performed using an inductive approach, supported by MAXQDA software to manage and organize data. Two independent researchers coded the transcripts; discrepancies in coding were resolved through consensus, ensuring a rigorous synthesis of the findings.

RESULTS

The workshop hosted 27 experts at the University of Arizona, 21 (78%) of whom were from public health-related fields. Of these 27 experts, 8 (30%) were from the field of resilience. In addition, participants from governmental agencies, American Indian groups, weather services, and a mobile health organization attended. Qualitative analysis identified major themes, including the potential of RI tools, threats to resilience (eg, health care access, infrastructure, and climate change), challenges with RI tools (eg, usability, funding, and real-time response), and standards for RI tools (eg, technological, logistical, and sociological). The attendees emphasized the importance of equitable access, community engagement, and iterative development in RI projects.

CONCLUSIONS

The RI workshop emphasized the necessity for accessible, user-friendly tools bridging technical knowledge and community needs. The workshop's conclusions provide a road map for future public health resilience, highlighting the need for scalable, culturally sensitive, community-driven interventions. Future directions include focused discussions to yield concrete outputs such as implementation guidelines and tool designs, reshaping public health strategies in the face of emerging threats.

Strategies and tactics to reduce the impact of healthcare on climate change: systematic review

OBJECTIVE

To review the international literature and assess the ways healthcare systems are mitigating and can mitigate their carbon footprint, which is currently estimated to be more than 4.4% of global emissions.

DESIGN

Systematic review of empirical studies and grey literature to examine how healthcare services and institutions are limiting their greenhouse gas (GHG) emissions.

DATA SOURCES

Eight databases and authoritative reports were searched from inception dates to November 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Teams of investigators screened relevant publications against the inclusion criteria (eg, in English; discussed impact of healthcare systems on climate change), applying four quality appraisal tools, and results are reported in accordance with PRISMA (preferred reporting items for systematic reviews and meta-analyses).

RESULTS

Of 33 737 publications identified, 32 998 (97.8%) were excluded after title and abstract screening; 536 (72.5%) of the remaining publications were excluded after full text review. Two additional papers were identified, screened, and included through backward citation tracking. The 205 included studies applied empirical (n=88, 42.9%), review (n=60, 29.3%), narrative descriptive (n=53, 25.9%), and multiple (n=4, 2.0%) methods. More than half of the publications (51.5%) addressed the macro level of the healthcare system. Nine themes were identified using inductive analysis: changing clinical and surgical practices (n=107); enacting policies and governance (n=97); managing physical waste (n=83); changing organisational behaviour (n=76); actions of individuals and groups (eg, advocacy, community involvement; n=74); minimising travel and transportation (n=70); using tools for measuring GHG emissions (n=70); reducing emissions related to infrastructure (n=63); and decarbonising the supply chain (n=48).

CONCLUSIONS

Publications presented various strategies and tactics to reduce GHG emissions. These included changing clinical and surgical practices; using policies such as benchmarking and reporting at a facility level, and financial levers to reduce emissions from procurement; reducing physical waste; changing organisational culture through workforce training; supporting education on the benefits of decarbonisation; and involving patients in care planning. Numerous tools and frameworks were presented for measuring GHG emissions, but implementation and evaluation of the sustainability of initiatives were largely missing. At the macro level, decarbonisation approaches focused on energy grid emissions, infrastructure efficiency, and reducing supply chain emissions, including those from agriculture and supply of food products. Decarbonisation mechanisms at the micro and meso system levels ranged from reducing low value care, to choosing lower GHG options (eg, anaesthetic gases, rescue inhalers), to reducing travel. Based on these strategies and tactics, this study provides a framework to support the decarbonisation of healthcare systems.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO: CRD42022383719.

Building health systems resilience: understanding the social, economic, and cultural impacts of climate change from stakeholders' perspectives in Indonesia

OBJECTIVES

This study explores stakeholders' perspectives on the direct, social, economic, and cultural impacts of climate change on health in Indonesia and identifies possible strategies to enhance health system resilience.

METHODS

This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines to ensure comprehensive and transparent reporting. Purposive sampling was used to select 22 stakeholders with relevant expertise, including government officials, representatives from international and professional health organizations, health workers, and community representatives. Semi-structured interviews were conducted, and data were analyzed using directed content analysis. Data saturation was reached when no new themes emerged.

RESULTS

The findings reveal significant challenges to Indonesia's health system due to climate change. Community awareness varies widely, with higher levels in disaster-prone areas. Socially, climate change has fostered community cooperation through collective adaptation efforts but has also led to tensions due to inequitable resource distribution. Economically, rising healthcare costs and financial instability, particularly in rural and disaster-prone regions, place a strain on the system. Culturally, there is a growing emphasis on environmental conservation, promoting eco-friendly practices and the integration of traditional and modern health approaches.

CONCLUSION

Building health system resilience in Indonesia requires addressing the social, economic, and cultural impacts of climate change. Possible strategies include enhancing public health education, strengthening healthcare infrastructure, improving inter-agency coordination, and leveraging technology to support effective responses to climate-related health threats, ultimately promoting national health, social stability, and economic growth.

Core Competencies of the Public Health Workforce in Climate Change and Extreme Weather Events Preparedness, Response, and Recovery: A Scoping Review

Climate change poses a significant threat to public health and safety, necessitating an urgent, coordinated response. Public health officials must be well-trained to effectively prepare for, respond to, and recover from extreme weather events. Despite emerging frameworks, a gap remains in their systematic application, risking future unpreparedness. This review aimed to identify the necessary competencies for public health professionals to manage climate change and the best methods to teach these skills. An academic librarian helped develop a keyword chain for a PubMed search, which included original articles and reviews concerning our research questions published in English or French between 1 January 2013 and 31 January 2024. Out of 255 potential articles, 31 were included in this scoping review. The results aligned with our objectives, revealing three main themes: core competencies, training and pedagogy strategies, and assessment approaches for public health professionals' preparedness, responses, and recovery in the context of climate change and extreme weather events. This scoping review enabled us to provide a set of clear recommendations for future research and practice in training the public health workforce for managing extreme weather events and climate change.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Biosensors for Public Health and Environmental Monitoring: The Case for Sustainable Biosensing

Climate change is a profound crisis that affects every aspect of life, including public health. Changes in environmental conditions can promote the spread of pathogens and the development of new mutants and strains. Early detection is essential in managing and controlling this spread and improving overall health outcomes. This perspective article introduces basic biosensing concepts and various biosensors, including electrochemical, optical, mass-based, nano biosensors, and single-molecule biosensors, as important sustainability and public health preventive tools. The discussion also includes how the sustainability of a biosensor is crucial to minimizing environmental impacts and ensuring the long-term availability of vital technologies and resources for healthcare, environmental monitoring, and beyond. One promising avenue for pathogen screening could be the electrical detection of biomolecules at the single-molecule level, and some recent developments based on single-molecule bioelectronics using the Scanning Tunneling Microscopy-assisted break junctions (STM-BJ) technique are shown here. Using this technique, biomolecules can be detected with high sensitivity, eliminating the need for amplification and cell culture steps, thereby enhancing speed and efficiency. Furthermore, the STM-BJ technique demonstrates exceptional specificity, accurately detects single-base mismatches, and exhibits a detection limit essentially at the level of individual biomolecules. Finally, a case is made here for sustainable biosensors, how they can help, the paradigm shift needed to achieve them, and some potential applications.

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.

Information sharing across institutions: Practices and barriers during public health emergencies in Ethiopia

BACKGROUND

Rapid, integrated information exchange between stakeholders is critical for effective emergency preparedness and response. However, many low- and middle-income countries face barriers to seamless data sharing. While information accessibility is recognized as important for evidence-based decision-making and resource allocation in Ethiopia, factors influencing current health information sharing practices among stakeholders involved in public health emergency management programs are unclear. This study aims to examine multi-sectoral stakeholders' perspectives and experiences with health data sharing during emergencies in Ethiopia, to identify opportunities and challenges influencing practices to strengthen the national public health emergency response system.

METHODS

A mixed-methods study was conducted between June and August 2023, involving a survey of 169 stakeholders actively involved in PHEM programs in Ethiopia as well as 23 in-depth interviews with key informants in senior leadership or advisory roles. The data was analyzed using descriptive statistics in SPSS and thematic analysis of qualitative transcripts.

RESULTS

During emergencies, it was observed that data sharing between different entities occurred. Quantitative findings showed the predominant types of health data shared between stakeholders during emergencies included hospital data (109, 64.5 %), clinical case information, and laboratory results. Challenges limiting effective coordination included issues like limited functionality of digital health systems (75, 44 %), incompatible data formats (13, 34 %), and financial constraints (83, 49 %) and and socio-cultural barriers constrain current practices in Ethiopia. Qualitative interviews identified five themes around risk communication and inclusive alert systems. Experts emphasized tailored, multichannel outreach but noted infrastructure gaps and digital divides currently limit poorer communities' engagement.

CONCLUSION

While collaborative health information exchange during emergencies is recognized as important, systemic, financial, and socio-cultural barriers constrain current practices in Ethiopia. Targeted strategies including capacity building, investment in integrated data infrastructure, economic optimization through innovative financing models, trust-based relationship development, and locally relevant communication channels informed by stakeholder perspectives can optimize information accessibility, coordination, quality, and equity of healthcare services during public health emergencies.

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.

Climate Change Adaptation Methods for Public Health Prevention in Australia: an Integrative Review

PURPOSE OF REVIEW

Climate change poses a serious threat to human health and well-being. Australia is not immune to the public health impacts and continues to be underprepared, putting the population health at risk. However, there is a dearth in knowledge about how the Australian public health system will address the impacts of climate change.

RECENT FINDINGS

This integrative review synthesises tools, frameworks, and guidance material suitable for climate change adaptation from a preventive public health perspective. The literature search was conducted in electronic databases MEDLINE, PubMed, CINAHL, and Web of Science. Of 4507 articles identified, 19 articles met the inclusion criteria that focused on operational methods in public health and excluded the clinical context and reactive disaster response approaches. This review revealed that Australia is ill-prepared to manage climate change adverse health impacts due to ineffective adaptation strategies. The review highlights that Australia urgently requires effective adaptation strategies such as undertaking a National Adaptation Plan process and an improved understanding in managing complex health risks. Taking this action will strengthen the public health system and build health resilience especially for vulnerable populations. These findings will help understand and develop of the necessary adaptive strategies in Australia.

From Health-in-All-Policies to Climate-in-All-Policies: Using the Synergies between Health Promotion and Climate Protection to Take Action

The climate crisis is developing into a life-changing event on a global level. Health promotion with the aim to increase the health status of individuals, independent of the present health status, has been developed on a scientific basis at least for the last eight decades. There are some basic principles which are prerequisites for both health promotion and climate protection. Those principles include (1) sustainability, (2) orientation on determinants, and (3) requirement of individual as well as community approaches. People are generally aiming to protect their lifestyle habits (e.g., traveling and consumer habits) and personal property (e.g., car and house) with easy solutions and as little effort as possible, and this can affect both health and climate. To reduce the emission of greenhouse gases and to protect our environment, changes towards a sustainable lifestyle have to be embedded into everybody's mind. Examples for domains that need to be addressed in health promotion as well as in climate protection include (health and climate) literacy, physical activity and active mobility, and nutrition and dietary habits. If health promotion fails to tackle those domains, this will continue to drive the climate crisis. And climate change, in turn, will affect health. On the other hand, developing and promoting health resources in the domains mentioned could help to mitigate the health-damaging effects of climate change. Success in the joint efforts to promote health and protect the climate would improve the One Health approach, the health of people and the environment.

Estimating changes in inequality of ecosystem services provided by green exposure: From a human health perspective

Ecosystem services provided by green spaces are closely related to human health, strongly supporting sustainable urban and territorial development. Urbanization has not only resulted in the reduction of green spaces but has also created inequalities in exposure. Inequitable green exposure creates disparities in residents' access to the ecosystem services provided by green spaces and can lead to significant health inequities. In this context, we first categorized green exposures into active and passive types based on their characteristics. Second, utilizing the benefit transfer method and Gini coefficient, we estimated the value and equity of ecosystem services offered by these green exposures around residences at the municipality level in Japan from 2000 to 2020, with a focus on human health implications. Finally, we explored the potential relationship between socioeconomics and ecosystem service inequity. Our findings reveal that: 1) ecosystem service value per capita and equity provided by green exposure are significantly different across municipalities; 2) although most municipalities show an upward trend in per capita ecosystem service value around residences, ecosystem service inequity increases significantly; and 3) ecosystem service inequity is related to the socioeconomic factors of municipalities and could be non-linear. The results of this study suggest that the government should adopt indicators related to the ecosystem services provided by green exposure during urban planning. While focusing on per-capita ecosystem services, they should also consider the equitable distribution of ecosystem services to promote sustainable urban health development.

Complex adaptive systems-based framework for modeling the health impacts of climate change

Introduction

Climate change is a global phenomenon with far-reaching consequences, and its impact on human health is a growing concern. The intricate interplay of various factors makes it challenging to accurately predict and understand the implications of climate change on human well-being. Conventional methodologies have limitations in comprehensively addressing the complexity and nonlinearity inherent in the relationships between climate change and health outcomes.

Objectives

The primary objective of this paper is to develop a robust theoretical framework that can effectively analyze and interpret the intricate web of variables influencing the human health impacts of climate change. By doing so, we aim to overcome the limitations of conventional approaches and provide a more nuanced understanding of the complex relationships involved. Furthermore, we seek to explore practical applications of this theoretical framework to enhance our ability to predict, mitigate, and adapt to the diverse health challenges posed by a changing climate.

Methods

Addressing the challenges outlined in the objectives, this study introduces the Complex Adaptive Systems (CAS) framework, acknowledging its significance in capturing the nuanced dynamics of health effects linked to climate change. The research utilizes a blend of field observations, expert interviews, key informant interviews, and an extensive literature review to shape the development of the CAS framework.

Results and discussion

The proposed CAS framework categorizes findings into six key sub-systems: ecological services, extreme weather, infectious diseases, food security, disaster risk management, and clinical public health. The study employs agent-based modeling, using causal loop diagrams (CLDs) tailored for each CAS sub-system. A set of identified variables is incorporated into predictive modeling to enhance the understanding of health outcomes within the CAS framework. Through a combination of theoretical development and practical application, this paper aspires to contribute valuable insights to the interdisciplinary field of climate change and health. Integrating agent-based modeling and CLDs enhances the predictive capabilities required for effective health outcome analysis in the context of climate change.

Conclusion

This paper serves as a valuable resource for policymakers, researchers, and public health professionals by employing a CAS framework to understand and assess the complex network of health impacts associated with climate change. It offers insights into effective strategies for safeguarding human health amidst current and future climate challenges.

Hearing Loss and Disorders: The Repercussions of Climate Change

PURPOSE

Climate change is considered to be the greatest threat to human health in the 21st century, and its effects are accelerating. Extensive research has clearly demonstrated its increasing impact across the continuum of health conditions. Despite this, there has been limited attention to the ramifications of climate change on hearing loss and hearing disorders. This lack of consideration is somewhat surprising as the environment itself and its changing nature have a substantial effect on hearing.

METHOD

Tackling climate change could be the greatest global health opportunity of the 21st century. To address this issue, this tutorial provides a general introduction to climate change and its three major elements (pollution, infectious diseases, and extreme weather events) and their effects on health. The substantial consequences of climate change for the incidence, development, and exacerbation of hearing loss and disorders are clearly described and detailed.

CONCLUSIONS

The challenge of responding to this very real and escalating threat to hearing requires a combination of prevention, advocacy, and education. These three roles place audiologists in the perfect position to take action on the far-reaching effects of climate change on hearing loss and disorders. To respond to this challenge and to fulfill these roles, several strategies, ranging from the individual level to the global level, are delineated for audiologists to incorporate into their practice.

Climate change and health equity: A public health perspective on climate justice

Background

The discourse on climate justice has developed from the theoretical approaches and discussions on environmental justice. A central tenet of the concept of environmental and climate justice is that environmental and climate issues cannot be seen in isolation from issues of social justice.

Methods

A conceptual model was developed on the relationship between climate change impacts, social dimensions, adaptive capacities, biological sensitivity, and health equity in order to systematically analyse climate justice. Based on an exploratory literature review and the evaluation of the individual contributions of the status report on climate change and health, the evidence in Germany on social inequalities in exposure to climate change impacts and vulnerability to their direct and indirect health effects was summarised.

Results

This paper provides an overview of the international debate and examples of evidence on climate justice in Germany. Climate justice in the sense of avoidable, unjust social inequalities in exposure, vulnerability, and the effects of climate mitigation and adaptation measures on health inequalities is still insufficiently addressed in Germany.

Conclusions

A consistent integration of equity issues into climate policy is necessary. With reference to the international literature, options for action and research needs are identified.

Exploring medical students' perceptions and understanding of the health impacts of climate change: a qualitative content analysis

BACKGROUND

Climate change has been identified as the greatest threat to global health in the twenty-first century, with its unfavorable health consequences being among its impacts on humans. Exploring the perspectives and understanding of healthcare professionals and service providers concerning climate change becomes imperative. The aim of this study is to investigate the perceptions and understanding of final-year medical students regarding the health impacts of climate change on individuals and the healthcare system using a qualitative content analysis.

METHODS

This study employed a qualitative content analysis approach. Face-to-face interviews were conducted with the aid of an interview guide to explore the students' awareness, understanding, and attitudes towards the impacts of climate change on public health and the healthcare system. The collected interview data were subsequently organized into codes, categories, and subcategories based on the students' perspectives and attitudes towards climate change.

RESULTS

Fifteen medical intern students were interviewed for this study, and the qualitative findings were categorized into 3 categories, 23 subcategories, and 229 codes. The study's findings revealed various health impacts of climate change, which were classified into three main categories, including environmental effects with 8 subcategories, socio-economic effects with 8 subcategories, and health effects with 7 subcategories. The study's findings revealed medical students' perceptions of various health impacts of climate change and These findings suggest that medical student understand that climate change has significant impacts on individuals' health and society, mainly through environmental degradation, increased risks, and climate-related disasters, which ultimately lead to adverse health outcomes.

CONCLUSIONS

The perspectives of medical students in this study indicate that climate change may not have a direct and immediate impact on the health of individuals and communities. However, it can significantly influence their health and socio-economic well-being by exacerbating or causing environmental problems, increasing the risk of weather-related events and natural disasters, ultimately leading to adverse health outcomes. While the medical students' perspectives on the health impacts of climate change are indeed broad, incorporating scientific knowledge about this topic into the medical curriculum and educating students on how to deal with patients affected by these consequences can have a significant impact on health management. This proactive approach, despite the students' already comprehensive understanding, can enhance their preparedness to address the health effects of climate change and contribute to strengthening the healthcare system's resilience in the face of climate-related challenges.

Strategies for public health adaptation to climate change in practice: social learning in the processionary Moth Knowledge Platform

Social learning theory can support understanding of how a group of diverse actors addresses complex challenges related to public health adaptation. This study focuses on one specific issue of public health adaptation: oak processionary moth (OPM) adaptation. With a social learning framework, we examined how public health adaption strategies gradually develop and are adjusted on the basis of new knowledge and experiences. For this qualitative case study, data were collected through 27 meetings of the Processionary Moth Knowledge Platform in the Netherlands and six additional interviews. Results indicate that relations between stakeholders, including experts played a major role in the learning process, facilitating the development and implementation of OPM adaptation and connecting local challenges to national adaptation strategies. Uncertainties regarding knowledge and organization were recurrent topics of discussion, highlighting the iterative and adaptive nature of public health adaptation. The study emphasizes the importance of building relationships among stakeholders and small steps in the learning process that can lead to the creation of new strategies and, if successful, the prevention of negative health impacts.

Health Equity Cannot Be Sought Without the Consideration of Racism In Equity-Focused Urban Health Initiatives

Given that racism is present worldwide, we believe it is imperative to address racism in the pursuit of health equity in cities. Despite the strengths of global urban health efforts in improving health equity, these initiatives can be furthered by explicitly considering systemic racism. Because racism is a major contributor to health issues, utilizing critical race theory (CRT) and taking an anti-racist perspective can help key players understand how racial health differences are initiated and sustained, which will subsequently inform solutions in seeking to address urban health inequities. Applying CRT within policymaking can happen in a variety of ways that are explored in this article. Ultimately, by acknowledging and responding to the effect of racism on groups within cities and the increased difficulties racialized minorities face, international players may use their power to transfer data and resources to cities that could benefit from specialized support.

Climate change and public health in Germany - An introduction to the German status report on climate change and health 2023

Global warming of 1.5°C and even 2°C is likely to be exceeded during the 21st century. Climate change poses a worldwide threat and has direct and indirect effects on infectious diseases, on non-communicable diseases and on mental health. Not all people are equally able to protect themselves against the impacts of climate change; particularly populations that are vulnerable due to individual factors (children, older persons, those immunocompromised or with pre-existing conditions), social factors (the socially disadvantaged), or living and working conditions (e. g. people who work outdoors) are subject to an increased risk. Concepts such as One Health or Planetary Health provide a framework to frame both climate change itself and adaptation strategies or sets of actions for environmental human and animal health. Knowledge of climate change impacts has grown in recent years, and mitigation and adaptation strategies have been developed.

Facilitating an Interprofessional Course on Climate Change and Public Health Preparedness

In this paper, we share the theories that guided the design of an interprofessional education course on Climate Change and Public Health Preparedness and how the course supported students' professional interest and action competence as they move through their education and into their professional work in the context of our unfolding climate crisis. The course was guided by the public health emergency preparedness domains and was built to allow for students to explore applications of the content for themselves and their own profession. We designed the learning activities to support personal and professional interest development and help students move into perceived and demonstrated action competence. For the evaluation of our course, we asked the following research questions: What kinds of personal and professional commitments to action did students propose by the end of the course? Did these vary in depth and specificity and by the number of credits they enrolled in? In what ways did students develop personal and professional action competence over the course? Finally, how did they show personal, professional, and collective agency related to the course content on adaptation, preparedness, and mitigation of the health impacts from climate change? Using qualitative analysis guided by action competence and interest development theories, we coded student writing from course assignments. We also conducted comparative statistical analysis to assess differential impacts for students who enrolled for one versus three credits. The results show that this course design supported students' progression of knowledge and perceived ability in specific individual and professional collective actions to reduce the health impacts of climate change.

Improving biology faculty diversity through a co-hiring policy and faculty agents of change

Persons Excluded due to Ethnicity and Race (PEERs) remain underrepresented in university faculties, particularly in science, technology, engineering, math and medicine (STEMM) fields, despite increasing representation among students, and mounting evidence supporting the importance of PEER faculty in positively impacting both scientific and educational outcomes. In fact, the ratio of PEER faculty to students has been steadily dropping since 2000. In our case study, we examine the factors that explain creation of an unusually diverse faculty within a biology department. We analyzed nearly 40 years of hiring data in the study department and show that this department (the study department), historically and currently, maintains a significantly higher proportion of PEERs on faculty as compared to two national datasets. Additionally, we identify factors that contributed to hiring of PEERs into tenure and tenure-track positions. We observed a significant increase in the hiring of PEERs concurrent with the implementation of a co-hiring policy (p = 0.04) which allowed a single search to make two hires when at least one candidate was a PEER. In contrast, three key informants at sister departments reported that co-hiring policies did not result in PEER hires, but instead different practices were effective. In line with one of these practices, we observe a possible association between search committees with at least one PEER member and PEER hiring (p = 0.055). Further, the presence of particular faculty members (Agents of Change) on search committees is associated with PEER hiring. In this case study the combination of a co-hire policy based on the principle of interest-convergence to redress hiring inequities, along with the presence of agents of change, increased faculty PEER representation in STEMM departments.

Climate Change Adaptation Activities and Needs in US State and Territorial Health Agencies

OBJECTIVE

To characterize US State and Territorial Health Agencies' (S/THA) climate change adaptation activities and priorities to facilitate appropriate investments, skills development, and support that will strengthen health sector capacity in response to a changing climate.

DESIGN

In 2021, we conducted an online survey of S/THA staff requesting information on current activities related to climate change and health, the state of climate and health programming, and anticipated needs and priorities for assistance. We analyzed survey results using descriptive statistics.

SETTING

US State and Territorial Health Agencies.

PARTICIPANTS

We received responses from 41 of 59 S/THAs (69.5%).

MAIN OUTCOME MEASURES

Implementation of S/THA climate and health programs (CHPs); engagement in climate and health activities; maintenance of hazard early warning systems and action plans; employment of climate and health communications strategies; capability to assess risks and adaptation needs related to various climate-sensitive conditions; priorities and plans for climate change adaptation in relation to climate-sensitive health risks; climate change adaptation-related partnerships and collaborations; requests of the Association of State and Territorial Health Officials (ASTHO) for advancing climate change adaptation activities; and the impacts of the COVID-19 pandemic on climate change work.

RESULTS

Nineteen S/THAs reported having CHPs, the majority of which are federally funded. On average, S/THAs without CHPs reported engagement in fewer climate and health activities and more early warning activities. The S/THAs reported the highest levels of concerns regarding non-vector-borne infectious disease (66%), vector-borne infectious diseases (61%), and extreme heat (61%) hazards.

CONCLUSIONS

As S/THAs with CHPs report substantially greater climate and health capacity than those without, additional federal and state investments (eg, Building Resilience Against Climate Effects [BRACE]) are urgently needed to catalyze climate and health capacity.

'Climate change mitigation is a hot topic, but not when it comes to hospitals': a qualitative study on hospital stakeholders' perception and sense of responsibility for greenhouse gas emissions

OBJECTIVE

Physical and mental well-being are threatened by climate change. Since hospitals in high-income countries contribute significantly to climate change through their greenhouse gas (GHG) emissions, the medical ethics imperative of 'do no harm' imposes a responsibility on hospitals to decarbonise. We investigated hospital stakeholders' perceptions of hospitals' GHG emissions sources and the sense of responsibility for reducing GHG emissions in a hospital.

METHODS

We conducted 29 semistructured qualitative expert interviews at one of Germany's largest hospitals, Heidelberg University Hospital. Five patients, 12 clinical and 12 administrative employees on different levels were selected using purposive maximum variation sampling. Interviews were transcribed verbatim and analysed using the framework approach.

RESULTS

Concerning GHG emissions, hospital stakeholders perceived energy and waste as most relevant emission sources followed by mobility. Climate change mitigation in general was considered as important. However, in their role as patients or employees, hospital stakeholders felt less responsible for climate change mitigation. They saw providing best possible medical care to be the top priority in hospitals and were often concerned that patients' health could be jeopardised by climate change mitigation measures.

CONCLUSION

Perceptions of most important emission sources did not coincide with those in literature, highlighting the need to inform stakeholders, for instance, about pharmaceuticals as important emission source. A frequently perceived conflict between reducing emissions and providing high-quality medical care could be eased, if reducing emissions would not only be justified as a contribution to mitigation, but also as a contribution to preventing ill health-a basic principle of medical ethics.

Creating Environmental Health Leaders When Educators Are Learning Too

The climate crisis is upon us, already exacting a health cost, with likely acceleration over our lifetimes. Our existing medical curricula do not adequately prepare medical students to deal with climate health nor to be leaders in the public health sphere. Current faculty have themselves not often been exposed to climate health training nor often to leadership training. This affords a unique opportunity for creative implementation of strategies to educate both faculty and students on how leadership skill building can complement the science and policy of climate health.

Uneven Growth in Social Capital Organizations After Disasters by Pre-Disaster Conditions in the United States 2000-2014

INTRODUCTION

Community-level social capital organizations are critical pre-existing resources that can be leveraged in a disaster.

AIM

The study aimed to test the hypothesis that communities with larger pre-disaster stocks of social capital organizations would maintain pre-disaster levels or experience growth.

METHODOLOGY

An annual panel dataset of counties in the contiguous United States from 2000 to 2014 totaling 46620 county-years, including longitudinal data on disasters and social capital institutions was used to evaluate the effect of disaster on growth of social capital.

RESULTS

When a county experienced more months of disasters, social capital organizations increased a year later. These findings varied based on the baseline level of social capital organizations. For counties experiencing minor disaster impacts, growth in social capital organizations tends to occur in counties with more social capital organizations in 2000; this effect is a countervailing finding to that of major disasters, and effect sizes are larger.

CONCLUSION

Given the growing frequency of smaller-scale disasters and the considerable number of communities that experienced these disasters, the findings suggest that small scale events create the most common and potentially broadest impact opportunity for intervention to lessen disparities in organizational growth.

Climate adaptive hospital: A systematic review of determinants and actions

Introduction

Climate change is among the most renowned concerns of the current century, endangering the lives of millions of people worldwide. To comply with the United Nations Climate Change Conference (COP21), hospitals should be on track to reduce greenhouse gas emissions. Although hospitals contribute to climate change by emitting greenhouse gases, they are also affected by the health consequences of climate change. Despite all the guidance provided, hospitals need more radical measures to confront climate change. The current study was carried out to examine the components of hospitals' adaptation to climate change and to review measures to confront climate change in hospitals.

Method

This systematic review was designed and carried out in 2020. The required information was collected from international electronic databases including Scopus, PubMed, Web of Science, EMBASE, and Google Scholar. Moreover, Iranian datasets such as Scientific Database (SID), Irandoc, Magiran, and IranMedex were reviewed. No restriction was considered in the methodology of the study. For the relevant thesis, the ProQuest database was also explored. The related sources were examined and the Snowball method was applied to find additional related studies. The research team also reviewed other accessible electronic resources, such as international guidelines and academic websites. The checklist of the Joanna Briggs Institute (JBI, 2017) was employed in order to evaluate the quality of the included papers. The studies published until June1, 2020, were included in the study.

Results

Of 11,680 published documents in the initial search, the full-texts of 140 were read after evaluating the titles and abstracts, of which 114 were excluded due to lack of sufficient information related to countermeasures in hospitals. Finally, the full-texts of 26 studies were reviewed to extract the required components. Two strategies were found, including climate change mitigation and climate change adaptation, with 13 components including water, wastewater, energy, waste, green buildings, food, transportation, green purchasing policy, medicines, chemicals and toxins, technology, sustainable care models, and leadership in hospitals were identified as affecting these measures and strategies.

Conclusion

Considering the significance of climate change and strategies to confront it as one of the current challenges and priorities in the world, it is necessary to develop a framework and model to reduce the effects of climate change and adapt to climate changes in hospitals and other health centers. The identification and classification of the measures and components, influencing hospital adaptability and solutions for reducing the climate change impacts could be the first stage in developing this strategy. This is because it is impossible to create this framework without identifying these factors and their mutual impacts at the first. In the present study, through a systematic review using a comprehensive approach, the related components were explored and divided into two categories, including measures to reduce the effects and measures to adapt to climate change. The results of this study can be useful in developing a comprehensive action model to reduce greenhouse gas emissions and adapt hospitals to climate change.

Climate Change Prevention through Community Actions and Empowerment: A Scoping Review

As society tries to tackle climate change around the globe, communities need to reduce its impact on human health. The purpose of this review is to identify key stakeholders involved in mitigating and adapting to climate change, as well as the type and characteristics of community empowerment actions implemented so far to address the problem. Published and unpublished studies from January 2005 to March 2022 in English and Portuguese were included in this review. The search, conducted on PubMed, CINAHL, Scopus, MEDLINE, Scopus, Web of Science, SciELO, and RCAAP (Repositório Científico de Acesso Aberto de Portugal), followed a three-step search strategy. Data extraction was performed by two independent reviewers, using an extraction tool specifically designed for the review questions. Twenty-seven studies were eligible for inclusion: six used interviews as a qualitative method, three were systematic reviews, three were case study analyses, three used surveys and questionnaires as quantitative methods, two used integrative baseline reviews, and three utilized a process model design. Six studies targeted local, public and private stakeholders. Community settings were the context target of fifteen studies, whereas twelve specifically referred to urban settings. Seven types of community actions were acknowledged across the globe, characterised as hybrid interventions and referring to the leading stakeholders: local governments, non-governmental organizations, civil society, universities, public health, and private sectors.

Impact of climate change on human health: evidence from riverine island dwellers of Bangladesh

This study aims to explore the impact of climate change on health, including local adaptation strategies. A mixed-method approach has been used in this study. The results reveal that increasing the frequency of flooding, severity of riverbank erosion and drought, and rising disease outbreak are the highest indicators of climate change perceived by riverine island (char) dwellers, which is similar to the observed data. It also uncovers, approximately all respondents encounter several health-related issues during different seasons where prevailing cold and cough with fever, skin diseases, and diarrhoea are the leading ailments. Several adaptation strategies are accommodated by char inhabitants in order to enhance resilience against the climate change health impacts, but the paucity of money, disrupted communication, lack of formal health-care centre are the most obstacles to the sustainability of adaptation. This research recommends that healthcare-associated project should be performed through proper monitoring for exterminating char dwellers' health issues.

Public Health Aspects of Climate Change Adaptation in Three Cities: A Qualitative Study

Climate change presents an unprecedented public health challenge as it has a great impact on population health outcomes across the global population. The key to addressing these health challenges is adaptation carried out in cities through collaboration between institutions, including public health ones. Through semi-structured interviews (n = 16), this study investigated experiences and perceptions of what public health aspects are considered by urban and public health planners and researchers when planning climate change adaptation in the coastal cities of Söderhamn (Sweden), Porto (Portugal) and Navotas (the Philippines). Results of the thematic analysis indicated that participating stakeholders were aware of the main climate risks threatening their cities (rising water levels and flooding, extreme temperatures, and air pollution). In addition, the interviewees talked about collaboration with other sectors, including the public health sector, in implementing climate change adaptation plans. However, the inclusion of the public health sector as a partner in the process was identified in only two cities, Navotas and Porto. Furthermore, the study found that there were few aspects pertaining to public health (water and sanitation, prevention of heat-related and water-borne diseases, and prevention of the consequences associated with heat waves in vulnerable groups such as children and elderly persons) in the latest climate change adaptation plans posted on each city's website. Moreover, participants pointed to different difficulties: insufficient financial resources, limited intersectoral collaboration for climate change adaptation, and lack of involvement of the public health sector in the adaptation processes, especially in one of the cities in which climate change adaptation was solely the responsibility of the urban planners. Studies using larger samples of stakeholders in larger cities are needed to better understand why the public health sector is still almost absent in efforts to adapt to climate change.

Legal implications of the climate-health crisis: A case study analysis of the role of public health in climate litigation

Background

Strong scientific evidence affirms that climate change is now a public health emergency. Increasingly, climate litigation brought against governments and corporations utilizes international human rights, environmental and climate laws and policies to seek accountability for climate-destructive and health-harming actions. The health impacts of climate change make litigation an important means of pursuing justice and strategically challenging legal systems. Yet there is scant documentation in the literature of the role that public health has played in climate litigation and the legal weight public health narratives are given in such contexts. Therefore, we assessed to what extent courts of law have used public health harm in legal adjudication and sought to provide practical recommendations to address barriers to positioning legal arguments in public health-centric frames.

Methods

We reviewed legal databases to identify all publicly reported, documented, cases of climate litigation filed in any country or jurisdiction between 1990 and September 2020. For the 1641 cases identified, we quantified the frequency of cases where health concerns were explicitly or implicitly raised.

Findings

Case numbers are trending upwards, notably in high income countries. Resolution remains pending in over half of cases as the majority were initiated in the past three years. Cases were primarily based in climate and human rights law and brought by a wide range of groups and individuals predominantly against governments. About half of the decided cases found in favour for the plaintiffs. Based on this, we selected the 65 cases that were directly linked to public health. We found economic forces and pricing of health risks play a key role, as courts are challenged by litigants to adjudicate on the responsibility for health impacts.

Conclusions

While courts of law are receptive to public health science, significant legal reform is needed to enhance leveraging of public health evidence in legal judgements of climate litigation cases. The integration of a public health mandate into a new eco-centric legal paradigm will optimize its potential to promote human well-being—the core objective underpinning both international law, human rights, and public health. Existing legal doctrines and practices can be enhanced to increase the weight of public health arguments in climate legal action and consequently ensure legal rulings in climate litigation prioritize, protect and promote public health.

An Examination of the Intersection of Climate Change, the Physician Specialty Workforce, and Graduate Medical Education in the U.S

Issue: As U.S. healthcare systems plan for future physician workforce needs, the systemic impacts of climate change, a worldwide environmental and health crisis, have not been factored in. The current focus on increasing the number of trained physicians and optimizing efficiencies in healthcare delivery may be insufficient. Graduate medical education (GME) priorities and training should be considered in order to prepare a climate-educated physician workforce. Evidence: We used a holistic lens to explore the available literature regarding the intersection of future physician workforce needs, GME program priorities, and resident education within the larger context of climate change. Our interinstitutional, transdisciplinary team brought perspectives from their own fields, including climate science, climate and health research, and medical education to provide recommendations for building a climate-educated physician workforce. Implications: Acknowledging and preparing for the effects of climate change on the physician workforce will require identification of workforce gaps, changes to GME program priorities, and education of trainees on the health and societal impacts of climate change. Alignment of GME training with workforce considerations and climate action and adaptation initiatives will be critical in ensuring the U.S. has a climate-educated physician workforce capable of addressing health and healthcare system challenges. This article offers a number of recommendations for physician workforce priorities, resident education, and system-level changes to better prepare for the health and health system impacts of climate change.

Cooling the City? A Scientometric Study on Urban Green and Blue Infrastructure and Climate Change-Induced Public Health Effects

Climate change causes global effects on multiple levels. The anthropogenic input of greenhouse gases increases the atmospheric mean temperature. It furthermore leads to a higher probability of extreme weather events (e.g., heat waves, floods) and thus strongly impacts the habitats of humans, animals, and plants. Against this background, research and innovation activities are increasingly focusing on potential health-related aspects and feasible adaptation and mitigation strategies. Progressing urbanization and demographic change paired with the climate change-induced heat island effect exposes humans living in urban habitats to increasing health risks. By employing scientometric methods, this scoping study provides a systematic bird’s eye view on the epistemic landscapes of climate change, its health-related effects, and possible technological and nature-based interventions and strategies in order to make urban areas climate proof. Based on a literature corpus consisting of 2614 research articles collected in SCOPUS, we applied network-based analysis and visualization techniques to map the different scientific communities, discourses and their interrelations. From a public health perspective, the results demonstrate the range of either direct or indirect health effects of climate change. Furthermore, the results indicate that a public health-related scientific discourse is converging with an urban planning and building science driven discourse oriented towards urban blue and green infrastructure. We conclude that this development might mirror the socio-political demand to tackle emerging climate change-induced challenges by transgressing disciplinary boundaries.

Back and Forth on Sustainable Development: A Focus on Healthcare Organisations

The sustainability of healthcare systems represents a relevant target of the 2030 Sustainable Development Goals Agenda. Nevertheless, academic research has neglected to study healthcare systems when focusing on the transition toward sustainable healthcare. This study addresses this gap by investigating the implementation of the sustainable development (SD) principle in the Italian healthcare system, in light of international and national institutional discourses on SD. A questionnaire-based survey has been directed to the General Directors (GDs) of government-funded healthcare orgsanisations to investigate their perceptions about the SD principle applied to healthcare, their strategic planning for SD, their implemented projects for sustainability and the intellectual capital factors that influence the latter’s implementation. The study was conducted in two waves: a first survey was administered in 2016, with a second one in 2021. We used content analysis to identify the potential differences emerging over time in GDs’ perceptions in light of the changes in the institutional discourse; we then assessed the differences over time in the perceived contribution of intellectual capital factors to the implementation of sustainability actions. Results show a substantial decrease in strategic planning for sustainability, as well as in the volume of sustainability projects implemented, as organisations were found to be less involved in implementing SD strategies and projects in 2021 than in 2016. Policies at the country level have mainly focused on balancing cost containment with quality targets, leaving the environmental dimension of sustainability and its connection with healthcare with limited guidelines. Regarding intellectual capital factors, organisational culture and technologies are increasingly perceived as enablers of SD; nevertheless, further studies are needed to deepen their effective contribution to sustainable healthcare.

Opioid treatment program safety measures during the COVID-19 pandemic: a statewide survey

Background

Opioid treatment programs (OTPs) serve as daily essential services for people with opioid use disorder. This study seeks to identify modifications to operations and adoption of safety measures at Pennsylvania OTPs during the COVID-19 pandemic.

Methods

A 25-min online survey to clinical and administrative directors at all 103 state-licensed OTPs in Pennsylvania was fielded from September to November 2020. Survey domains included: 1) changes to services, client volume, hours and staffing during the COVID-19 pandemic 2) types of services modifications 3) safety protocols to reduce COVID-19 transmission 4) challenges to operations during the pandemic.

Results

Forty-seven directors responded, for a response rate of 45%. Almost all respondents reported making some service modification (96%, n = 43). Almost half (47%, n = 21) of respondents reported reductions in the number of clients served. OTPs were more likely to adopt safety protocols that did not require significant funding, such as limiting the number of people entering the site (100%, n = 44), posting COVID-safety information (100%, n = 44), enforcing social distancing (98%, n = 43), and increasing sanitation (100%, n = 44). Only 34% (n = 14) of OTPS provided N95 masks to most or all staff. Respondents reported that staff’s stress and negative mental health (86%, n = 38) and staff caregiving responsibilities (84%, n = 37) during the pandemic were challenges to maintaining OTP operations.

Conclusion

OTPs faced numerous challenges to operations and adoption of safety measures during the COVID-19 pandemic. Funding mechanisms and interventions to improve adoption of safety protocols, staff mental health as well as research on patient experiences and preferences can inform further OTP adaptation to the COVID-19 pandemic and future emergency planning.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07832-7.

The Ethical Duty to Reduce the Ecological Footprint of Industrialized Healthcare Services and Facilities

According to the widely accepted principles of beneficence and distributive justice, I argue that healthcare providers and facilities have an ethical duty to reduce the ecological footprint of the services they provide. I also address the question of whether the reductions in footprint need or should be patient-facing. I review Andrew Jameton and Jessica Pierce's claim that achieving ecological sustainability in the healthcare sector requires rationing the treatment options offered to patients. I present a number of reasons to think that we should not ration health care to achieve sufficient reductions in a society's overall consumption of ecological goods. Moreover, given the complexities of ecological rationing, I argue that there are good reasons to think that the ethical duty to reduce the ecological footprint of health care should focus on only nonpatient-facing changes. I review a number of case studies of hospitals who have successfully retrofitted facilities to make them more efficient and reduced their resource and waste streams.

Studying how state health services delivery policies can mitigate the effects of disasters on drug addiction treatment and overdose: Protocol for a mixed-methods study

BACKGROUND

The United States is experiencing a drug addiction and overdose crisis, made worse by the COVID-19 pandemic. Relative to other types of health services, addiction treatment and overdose prevention services are particularly vulnerable to disaster-related disruptions for multiple reasons including fragmentation from the general medical system and stigma, which may lead decisionmakers and providers to de-prioritize these services during disasters. In response to the COVID-19 pandemic, U.S. states implemented multiple policies designed to mitigate disruptions to addiction treatment and overdose prevention services, for example policies expanding access to addiction treatment delivered via telehealth and policies designed to support continuity of naloxone distribution programs. There is limited evidence on the effects of these policies on addiction treatment and overdose. This evidence is needed to inform state policy design in future disasters, as well as to inform decisions regarding whether to sustain these policies post-pandemic.

METHODS

The overall study uses a concurrent-embedded design. Aims 1-2 use difference-in-differences analyses of large-scale observational databases to examine how state policies designed to mitigate the effects of the COVID-19 pandemic on health services delivery influenced addiction treatment delivery and overdose during the pandemic. Aim 3 uses a qualitative embedded multiple case study approach, in which we characterize local implementation of the state policies of interest; most public health disaster policies are enacted at the state level but implemented at the local level by healthcare systems and local public health authorities.

DISCUSSION

Triangulation of results across methods will yield robust understanding of whether and how state disaster-response policies influenced drug addiction treatment and overdose during the COVID-19 pandemic. Results will inform policy enactment and implementation in future public health disasters. Results will also inform decisions about whether to sustain COVID-19 pandemic-related changes to policies governing delivery addiction and overdose prevention services long-term.

Health promotion and harm reduction attributes in One Health literature: A scoping review

One Health faces enormous pressure and challenges as it attempts to mitigate dynamic, surprising and complex global events that threaten the health and sustainability of human and animal populations and the biosphere. One Health practitioners and researchers need every advantage to developing working solutions to the world's imminent complex issues. Heath promotion and harm reduction, interrelated approaches that have seen much success over decades of use in global public health, may be important models to consider. Both use an upstream socioecological determinant of health approach to reach beyond the health sector in all health efforts, and encourage active community participation and empowerment to attain and sustain human and ecological health. This scoping review of 411 documents, believed to be the first to relate health promotion and harm reduction to One Health, searched self-declared One Health research literature for evidence of health promotion and harm reduction policies, principles and methodologies. It sought to answer the questions: "What is the scope of practice of One Health in self-declared One Health publications?" and "Are attributes of health promotion and harm reduction found in self-declared One Health-reviewed research literature?" Over half of the papers revealed no health promotion or harm reduction attributes while 7% were well-endowed with these attributes. These 7% of papers focused on deep-seated, complex health issues with systemic knowledge gaps and decision-making issues revolving around specific population vulnerabilities, social inequities and competing stakeholders. Implementing 'on the ground change' was a common theme in the strongest health promotion/harm reduction papers we identified. Alternatively, papers lacking health promotion or harm reduction attributes focused on managing proximate risks, primarily for infectious diseases. The addition of health promotion and harm reduction to One Health practices may help the field rise to the growing expectations for its involvement in complex global issues like pandemics and climate change.

A randomized cross-over trial investigating differences in 24-h personal air and skin temperatures using wearable sensors between two climatologically contrasting settings

The influence of elevated air temperatures recorded in various urban microenvironments in adversely impacting biologically relevant disease end points has not yet been extensively tackled. This study is a post hoc analysis of the TEMP pilot trial, a randomized 2 × 2 cross-over trial that examined changes in metabolic and stress hormonal profiles of healthy adults in two settings (urban vs. rural) with distinctly different climatological characteristics during the Mediterranean summer. This analysis aimed to study the association between the 24-h personal air or skin temperature sensor measurements and the diary-based location type (indoors vs. outdoors) in urban (seaside) vs. rural (higher in altitude) microenvironments. Out of 41 eligible participants, a total of 37 participants were included in this post-hoc TEMP trial analysis. Wearable sensors recorded personal air temperature, skin temperature, and activity (as a surrogate marker of physical activity) in each setting, while a time-stamped personal diary recorded the types of indoor or outdoor activities. Temperature peaks during the 24-h sampling period were detected using a peak finding algorithm. Mixed effect logistic regression models were fitted for the odds of participant location (being indoors vs. outdoors) as a function of setting (urban vs. rural) and sensor-based personal temperature data (either raw temperature values or number of temperature peaks). During the study period (July-end of September), median [interquartile range, IQR] personal air temperature in the rural (higher altitude) settings was 1.5 °C lower than that in the urban settings (27.1 °C [25.4, 29.2] vs. 28.6 °C [27.1, 30.5], p < 0.001), being consistent with the Mediterranean climate. Median [IQR] personal air temperature in indoor (micro)environments was lower than those in outdoors (28.0 °C [26.4, 30.3] vs 28.5 °C [26.8, 30.7], p < 0.001). However, median [IQR] skin temperature was higher in indoor (micro)environments vs. outdoors (34.8 °C [34.0, 35.6] and 33.9 °C [32.9, 34.8], p < 0.001) and the number of both personal air and skin temperature peaks was higher indoors compared to outdoors (median [IQR] 3.0 [2.0,4.0] vs 1.0 [1.0,1.3], p < 0.007, for the skin sensors). A significant association between the number of temperature peaks and indoor location types was observed with either the personal air sensor (OR 3.1; 95% CI 1.2-8.2; p = 0.02) or the skin sensor (OR 3.7; 95% CI 1.4-9.9; p = 0.01), suggesting higher number of indoor air temperature fluctuations. Amidst the global climate crisis, more population health studies or personalized medicine approaches that utilize continuous tracking of individual-level air/skin temperatures in both indoor/outdoor locations would be warranted, if we were to better characterize the disease phenotype in response to climate change manifestations.

Phytoremediation: The Sustainable Strategy for Improving Indoor and Outdoor Air Quality

Most of the world’s population is exposed to highly polluted air conditions exceeding the WHO limits, causing various human diseases that lead towards increased morbidity as well as mortality. Expenditures on air purification and costs spent on the related health issues are rapidly increasing. To overcome this burden, plants are potential candidates to remove pollutants through diverse biological mechanisms involving accumulation, immobilization, volatilization, and degradation. This eco-friendly, cost-effective, and non-invasive method is considered as a complementary or alternative tool compared to engineering-based remediation techniques. Various plant species remove indoor and outdoor air pollutants, depending on their morphology, growth condition, and microbial communities. Hence, appropriate plant selection with optimized growth conditions can enhance the remediation capacity significantly. Furthermore, suitable supplementary treatments, or finding the best combination junction with other methods, can optimize the phytoremediation process.

Climate, Carbon Dioxide, and Plant-Based Aero-Allergens: A Deeper Botanical Perspective

There is global evidence of a general increase in the incidence and prevalence of respiratory diseases including allergic rhinitis and associated asthma. This increase in turn, has been related, in part, to concurrent increases in carbon dioxide (CO2) and temperature on pollen production and allergic disease generated from plant-based sources of pollen. Such links to anthropogenic climate change has suggested three significant and interrelated consequences associated with respiratory allergies or disease. First, warmer temperatures and a longer frost-free growing season can influence pollen season length and temporal exposure to airborne aeroallergens. Second, both warmer temperatures and additional CO2 can increase the amount of pollen, the seasonal intensity, from spring through fall. Thirdly, there is evidence from oak and ragweed that rising levels of CO2 could increase the allergen concentration of the pollen and symptom severity. However, while these outcomes are of obvious consequence, they do not fully encompass all of the plant derived changes that could, directly or indirectly, influence aeroallergen production, exposure, and consequences for public health. In this overview, I will delve deeper into other plant-based links to climate/CO2 that are consequential either directly or indirectly to allergic rhinitis and associated disease. Such interactions range from pollen morphology to fire occurrence, from volatile organic compounds to potential changes in pesticide usage. The goal in doing so is to provide a broader context and appreciation for the interactions between plant biology and climate that can also affect allergen production and human impact but which, to date, have received little recognition or research.

Understanding Mosquito Surveillance Data for Analytic Efforts: A Case Study

Mosquito surveillance data can be used for predicting mosquito distribution and dynamics as they relate to human disease. Often these data are collected by independent agencies and aggregated to state and national level portals to characterize broad spatial and temporal dynamics. These larger repositories may also share the data for use in mosquito and/or disease prediction and forecasting models. Assumed, but not always confirmed, is consistency of data across agencies. Subtle differences in reporting may be important for development and the eventual interpretation of predictive models. Using mosquito vector surveillance data from Arizona as a case study, we found differences among agencies in how trapping practices were reported. Inconsistencies in reporting may interfere with quantitative comparisons if the user has only cursory familiarity with mosquito surveillance data. Some inconsistencies can be overcome if they are explicit in the metadata while others may yield biased estimates if they are not changed in how data are recorded. Sharing of metadata and collaboration between modelers and vector control agencies is necessary for improving the quality of the estimations. Efforts to improve sharing, displaying, and comparing vector data from multiple agencies are underway, but existing data must be used with caution.