[The climate crisis as an ethical challenge]

Climate change is a threat to health and social security of billions of people. Health and quality of life are increasingly affected in many ways due to the climate crisis. Rising global temperatures are resulting in increasingly frequent and severe extreme weather events, contributing to further increase in inequality, discrimination, and injustice overall and in health care specifically. Furthermore, climatic conditions are also becoming increasingly suitable for the transmission of infectious diseases and their spread into new regions. Socio-economically disadvantaged regions with weak health infrastructure (e.g. Global South) will be hardly able to cope without specific support. The overriding imperative is to achieve reductions in greenhouse gas emissions from transport, energy and food production at global, national and regional levels to mitigate negative health impacts. The 2015 Paris Agreement must also be seen as crucial health agreement. Our paper aims to highlight ethical aspects of climate change in the health sector.

Health Symptoms Related to Pesticide Use in Farmers and Laborers of Ecological and Conventional Banana Plantations in Ecuador

Conventional banana farming is pesticide-intensive and leads to high exposure of farmworkers. Ecuador is the world’s biggest exporter of bananas. In this field study in 5 communities in Ecuador, we recorded potentially pesticide-associated subjective health symptoms in farmworkers and compared pesticide users to workers in organic farming. With one exception, symptom rates were always higher in the pesticide-exposed group. Significance was reached in 8 out of 19 investigated symptoms with the highest odds ratios (and smallest p-values) for local irritation like skin and eye irritation (OR = 3.58, CI 1.10–11.71, and 4.10, CI 1.37–12.31, respectively) as well as systemic symptoms like dizziness (OR = 4.80, CI 1.55–14.87) and fatigue (OR = 4.96, CI 1.65–14.88). Moreover, gastrointestinal symptoms were reported more frequently by pesticide users: nausea (OR = 7.5, CI 1.77–31.77) and diarrhea (OR = 6.43, CI 1.06–30.00). The majority of farmworkers were not adequately protected from pesticide exposure. For example, only 3 of 31 farmworkers that had used pesticides recently reported using gloves and only 6 reported using masks during active spraying. Improved safety measures and a reduction in pesticide use are necessary to protect the health of banana farmworkers.

Air Pollution Is Associated with COVID-19 Incidence and Mortality in Vienna, Austria

We determined the impact of air pollution on COVID-19-related mortality and reported-case incidence, analyzing the correlation of infection case numbers and outcomes with previous-year air pollution data from the populations of 23 Viennese districts. Time at risk started in a district when the first COVID-19 case was diagnosed. High exposure levels were defined as living in a district with an average (year 2019) concentration of nitrogen dioxide (NO2) and/or particulate matter (PM10) higher than the upper quartile (30 and 20 µg/m3, respectively) of all districts. The total population of the individual districts was followed until diagnosis of or death from COVID-19, or until 21 April 2020, whichever came first. Cox proportional hazard regression was performed after controlling for percentage of population aged 65 and more, percentage of foreigners and of persons with a university degree, unemployment rate, and population density. PM10 and NO2 were significantly and positively associated with the risk of a COVID-19 diagnosis (hazard ratio (HR) = 1.44 and 1.16, respectively). NO2 was also significantly associated with death from COVID-19 (HR = 1.72). Even within a single city, higher levels of air pollution are associated with an adverse impact on COVID-19 risk.

Nitrogen-Dioxide Remains a Valid Air Quality Indicator

In epidemiological studies, both spatial and temporal variations in nitrogen dioxide (NO₂) are a robust predictor of health risks. Compared to particulate matter, the experimental evidence for harmful effects at typical ambient concentrations is less extensive and not as clear for NO₂. In the wake of the “Diesel emission scandal—Dieselgate”, the scientific basis of current limit values for ambient NO₂ concentrations was attacked by industry lobbyists. It was argued that associations between NO₂ levels and medical endpoints were not causal, as NO₂ in older studies served as a proxy for aggressive particulate matter from incineration processes. With the introduction of particle filters in diesel cars, NO₂ would have lost its meaning as a health indicator. Austria has a high percentage of diesel-powered cars (56%). If, indeed, associations between NO₂ concentrations and health risks in previous studies were only due to older engines without a particle filter, we should expect a reduction in effect estimates over time as an increasing number of diesel cars on the roads were outfitted with particle filters. In previous time series studies from Vienna over shorter time intervals, we have demonstrated distributed lag effects over days up to two weeks and previous day effects of NO₂ on total mortality. In a simplified model, we now assess the effect estimates for moving 5-year periods from the beginning of NO₂ monitoring in Vienna (1987) until the year 2018 of same and previous day NO₂ on total daily mortality. Contrary to industry claims of a spurious, no longer valid indicator function of NO₂, effect estimates remained fairly stable, indicating an increase in total mortality of previous day NO₂ by 0.52% (95% CI: 0.35–0.7%) per 10 µg/m³ change in NO₂ concentration.

Time Course of COVID-19 Cases in Austria

COVID-19 is an infectious disease caused by a novel coronavirus, which first appeared in China in late 2019, and reached pandemic distribution in early 2020. The first major outbreak in Europe occurred in Northern Italy where it spread to neighboring countries, notably to Austria, where skiing resorts served as a main transmission hub. Soon, the Austrian government introduced strict measures to curb the spread of the virus. Using publicly available data, we assessed the efficiency of the governmental measures. We assumed an average incubation period of one week and an average duration of infectivity of 10 days. One week after the introduction of strict measures, the increase in daily new cases was reversed, and the reproduction number dropped. The crude estimates tended to overestimate the reproduction rate in the early phase. Publicly available data provide a first estimate about the effectiveness of public health measures. However, more data are needed for an unbiased assessment.

Indicators of Genotoxicity in Farmers and Laborers of Ecological and Conventional Banana Plantations in Ecuador

Banana farming represents an important segment of agricultural production in Ecuador. The health of farmworkers might be compromised by the extensive use of pesticides in plantations applied under poorly regulated conditions. Due to an increased awareness of pesticide-related problems for nature, as well as for worker and consumer health, ecological farming has been established in some plantations of Ecuador. We set out to investigate the occupational health of workers in both conventional and ecological farming. Nuclear anomalies in buccal epithelial cells were used as short-term indicators for genotoxicity and a potentially increased cancer risk in the two groups of farmworkers. By application of the Buccal Micronucleus Cytome Assay (BMCA), we found the frequency of micronuclei in conventional pesticide using farmworkers significantly increased by 2.6-fold, and other nuclear anomalies significantly increased by 24% to 80% (except pyknosis with a non-significant increase of 11%) compared to the farmworkers on ecological plantations. These results demonstrate that ecological farming may provide an alternative to extensive pesticide use with significantly reduced indicators of cancer risk. In conventional farming, improvements in education and instruction regarding the safe handling of pesticides and protective equipment, as well as regulatory measures, are urgently needed.

Alien Species and Human Health: Austrian Stakeholder Perspective on Challenges and Solutions

No saturation in the introduction, acceleration of spread and the increasing impacts of alien species are a characteristic feature of the Anthropocene. Concomitantly, alien species affecting human health are supposed to increase, mainly due to increasing global trade and climate change. In this study, we assess challenges and solutions posed by such species to the public health sector in Austria over the next few decades. We did so using an online questionnaire circulated to 131 experts and stakeholders working on human health and biological invasions, supplemented by in-depth interviews with eleven selected experts. Results from the online survey and in-depth interviews largely support and complement each other. Experts and stakeholders suggest that (i) the allergenic Ambrosia artemisiifolia (common ragweed), the photodermatoxic Heracleum mantegazzianum (giant hogweed), and vectors of diseases such as Aedes albopictus (Asian tiger mosquito) are considered the alien species posing the most severe challenges; (ii) challenges are expected to increase in the next few decades and awareness in the public health sector is not sufficient; (iii) effective and efficient solutions are mainly related to prevention. Specific solutions include pathway management of introduction and spread by monitoring and controlling established populations of ragweed, hogweed and mosquitos.

Subjective Symptoms of Male Workers Linked to Occupational Pesticide Exposure on Coffee Plantations in the Jarabacoa Region, Dominican Republic

Acute and sub-acute effects of pesticide use in coffee farmers have rarely been investigated. In the present field study, self-reported health symptoms from 38 male pesticide users were compared to those of 33 organic farmers. Results of cytological findings have been reported in an accompanying paper in this issue. The present second part of the study comprises a questionnaire based survey for various, potentially pesticide related symptoms among the coffee farmers. Symptom rates were generally higher in exposed workers, reaching significance in nine out of 19 assessed symptoms. Significantly increased symptom frequencies were related to neurotoxicity, parasympathic effects and acetylcholine esterase inhibition, with the highest differences found for excessive salivation, dizziness and stomach ache. We revealed a lack of precautionary measures in the majority of farmers. Better education, regulations, and safety equipment are urgently needed.