Bibliográfia - Az éghajlatváltozás hatása az egészségügyi ellátásra

1. Rocklöv J, Huber V, Bowen K, Paul R. Taking globally consistent health impact projections to the next level. Lancet Planet Health. 2021 Jul;5(7):e487-e493. doi: 10.1016/S2542-5196(21)00171-6. PMID: 34245719.



Despite intensive research activity within the area of climate change, substantial knowledge gaps still remain regarding the potential future impacts of climate change on human health. A key shortcoming in the scientific understanding of these impacts is the lack of studies that are conducted in a coordinated and consistent fashion, producing directly comparable outputs. This Viewpoint discusses and exemplifies a bottom-up initiative generating new research evidence in a more coordinated and consistent way compared with previous efforts. It describes one of the largest model comparisons of projected health impacts due to climate change, so far. Yet, the included studies constitute only a selection of health impacts in a variety of geographical locations, and are therefore not a comprehensive assessment of all possible impact pathways and potential consequences. The new findings of these studies shed light on the complex and multidirectional impacts of climate change on health, where impacts can be both adverse or beneficial. However, the adverse impacts dominate overall, especially in the scenarios with more greenhouse gas forcing. Overall, the future population at risk of disease and incidence rates are predicted to increase substantially, but in a highly location-specific and disease-specific fashion. Greenhouse gas emission mitigation can substantially reduce risk and resultant morbidity and mortality. The potential positive impact of adaptation has not been included in the models applied, and thus remains a major source of uncertainty. This bottom-up initiative lays out a research strategy that brings more meaningful research outputs and calls for greater coordination of research initiatives across the health community.



2. Gallagher CA, Keehner JR, Hervé-Claude LP, Stephen C. Health promotion and harm reduction attributes in One Health literature: A scoping review. One Health. 2021 Jul 9;13:100284. doi: 10.1016/j.onehlt.2021.100284. PMID: 34381864; PMCID: PMC8339253.


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.



3. McDermott-Levy R, Scolio M, Shakya KM, Moore CH. Factors That Influence Climate Change-Related Mortality in the United States: An Integrative Review. Int J Environ Res Public Health. 2021 Aug 3;18(15):8220. doi: 10.3390/ijerph18158220. PMID: 34360518; PMCID: PMC8345936.


Global atmospheric warming leads to climate change that results in a cascade of events affecting human mortality directly and indirectly. The factors that influence climate change-related mortality within the peer-reviewed literature were examined using Whittemore and Knafl's framework for an integrative review. Ninety-eight articles were included in the review from three databases-PubMed, Web of Science, and Scopus-with literature filtered by date, country, and keywords. Articles included in the review address human mortality related to climate change. The review yielded two broad themes in the literature that addressed the factors that influence climate change-related mortality. The broad themes are environmental changes, and social and demographic factors. The meteorological impacts of climate change yield a complex cascade of environmental and weather events that affect ambient temperatures, air quality, drought, wildfires, precipitation, and vector-, food-, and water-borne pathogens. The identified social and demographic factors were related to the social determinants of health. The environmental changes from climate change amplify the existing health determinants that influence mortality within the United States. Mortality data, national weather and natural disaster data, electronic medical records, and health care provider use of International Classification of Disease (ICD) 10 codes must be linked to identify climate change events to capture the full extent of climate change upon population health.

Keywords: climate change; climate change-related mortality; integrative review; mortality.



4. Coakley S, Petti C. Impacts of the Invasive Impatiens glandulifera: Lessons Learned from One of Europe's Top Invasive Spieces. Biology (Basel). 2021 Jul 3;10(7):619. doi: 10.3390/biology10070619. PMID: 34356476; PMCID: PMC8301180.



Biological invasions are renowned for their negative ecological and economic implications, however from studying invasions invaluable insights can be gained in the fields of ecology and evolution- potentially contributing towards conservation plans to deal, not only with biological invasion, but with other concerning issues, such as climate change. Impatiens glandulifera, or Himalayan balsam, is widely considered to be a highly problematic invasive, having spread across more than thirty countries during the past century. This paper will examine the findings which have arose from studying I. glandulifera and its impacts on the invaded ecosystem.

Keywords: Impatiens glandulifera; alien species; biological invasion; conservation biology; invasive.



5. Mondejar ME, Avtar R, Diaz HLB, Dubey RK, Esteban J, Gómez-Morales A, Hallam B, Mbungu NT, Okolo CC, Prasad KA, She Q, Garcia-Segura S. Digitalization to achieve sustainable development goals: Steps towards a Smart Green Planet. Sci Total Environ. 2021 Jun 19;794:148539. doi: 10.1016/j.scitotenv.2021.148539. Epub ahead of print. PMID: 34323742.


Digitalization provides access to an integrated network of unexploited big data with potential benefits for society and the environment. The development of smart systems connected to the internet of things can generate unique opportunities to strategically address challenges associated with the United Nations Sustainable Development Goals (SDGs) to ensure an equitable, environmentally sustainable, and healthy society. This perspective describes the opportunities that digitalization can provide towards building the sustainable society of the future. Smart technologies are envisioned as game-changing tools, whereby their integration will benefit the three essential elements of the food-water-energy nexus: (i) sustainable food production; (ii) access to clean and safe potable water; and (iii) green energy generation and usage. It then discusses the benefits of digitalization to catalyze the transition towards sustainable manufacturing practices and enhance citizens' health wellbeing by providing digital access to care, particularly for the underserved communities. Finally, the perspective englobes digitalization benefits by providing a holistic view on how it can contribute to address the serious challenges of endangered planet biodiversity and climate change.



6. DeVille NV, Tomasso LP, Stoddard OP, Wilt GE, Horton TH, Wolf KL, Brymer E, Kahn PH Jr, James P. Time Spent in Nature Is Associated with Increased Pro-Environmental Attitudes and Behaviors. Int J Environ Res Public Health. 2021 Jul 14;18(14):7498. doi: 10.3390/ijerph18147498. PMID: 34299948; PMCID: PMC8305895.



Urbanization, screen dependency, and the changing nature of childhood and parenting have led to increased time indoors, creating physical and emotional distancing from nature and time spent in natural environments. Substantial evidence from observational and intervention studies indicates that overall time spent in nature leads to increased perceived value for connectedness to nature and, subsequently, greater pro-environmental attitudes and behaviors (PEAB). This narrative review of the recent literature evaluates associations between time spent in nature with values ascribed to nature and nature connectedness, as well as PEAB. We discuss the influence of nature exposure and education in childhood on subsequent development of PEAB in adulthood. We analyze theoretical frameworks applied to this research as well as metrics employed, populations studied, and individual and societal values before presenting limitations of this research. We conclude with suggestions for future research directions based on current knowledge, underscoring the importance of promoting time spent in nature and PEAB in the face of growing challenges to planetary health. Research indicates that overall time spent in nature, regardless of the quality of environmental conditions, leads to increased perceived values ascribed to nature, which is associated with PEAB; however, this literature is predominantly cross-sectional. Furthermore, personal and social factors may influence PEAB. Thus, more longitudinal studies that consider these factors are needed to assess the duration and frequency of time spent in nature in childhood and its impact on PEAB throughout the life course. Identifying contexts which cultivate PEAB and reverse alienation from nature beginning in childhood may better sensitize adults to the urgency of environmental issues such as climate change, which adversely impact individual and environmental health.

Keywords: environmental attitudes; environmental behaviors; environmental education; environmental values; nature; nature affinity; nature experience; nature exposure; pro-environmentalism; time in nature.



7. Agyekum TP, Botwe PK, Arko-Mensah J, Issah I, Acquah AA, Hogarh JN, Dwomoh D, Robins TG, Fobil JN. A Systematic Review of the Effects of Temperature on Anopheles Mosquito Development and Survival: Implications for Malaria Control in a Future Warmer Climate. Int J Environ Res Public Health. 2021 Jul 7;18(14):7255. doi: 10.3390/ijerph18147255. PMID: 34299706; PMCID: PMC8306597.


The rearing temperature of the immature stages can have a significant impact on the life-history traits and the ability of adult mosquitoes to transmit diseases. This review assessed published evidence of the effects of temperature on the immature stages, life-history traits, insecticide susceptibility, and expression of enzymes in the adult Anopheles mosquito. Original articles published through 31 March 2021 were systematically retrieved from Scopus, Google Scholar, Science Direct, PubMed, ProQuest, and Web of Science databases. After applying eligibility criteria, 29 studies were included. The review revealed that immature stages of An. arabiensis were more tolerant (in terms of survival) to a higher temperature than An. funestus and An. quadriannulatus. Higher temperatures resulted in smaller larval sizes and decreased hatching and pupation time. The development rate and survival of An. stephensi was significantly reduced at a higher temperature than a lower temperature. Increasing temperatures decreased the longevity, body size, length of the gonotrophic cycle, and fecundity of Anopheles mosquitoes. Higher rearing temperatures increased pyrethroid resistance in adults of the An. arabiensis SENN DDT strain, and increased pyrethroid tolerance in the An. arabiensis SENN strain. Increasing temperature also significantly increased Nitric Oxide Synthase (NOS) expression and decreased insecticide toxicity. Both extreme low and high temperatures affect Anopheles mosquito development and survival. Climate change could have diverse effects on Anopheles mosquitoes. The sensitivities of Anopeheles mosquitoes to temperature differ from species to species, even among the same complex. Notwithstanding, there seem to be limited studies on the effects of temperature on adult life-history traits of Anopheles mosquitoes, and more studies are needed to clarify this relationship.

Keywords: Anopheles mosquito; body size; fecundity; gonotrophic cycle; immature stage; insecticide; longevity; temperature.



8. Echevarría-Lucas L, Senciales-González JM, Medialdea-Hurtado ME, Rodrigo-Comino J. Impact of Climate Change on Eye Diseases and Associated Economical Costs. Int J Environ Res Public Health. 2021 Jul 5;18(13):7197. doi: 10.3390/ijerph18137197. PMID: 34281132; PMCID: PMC8297364.


Climate change generates negative impacts on human health. However, little is known about specific impacts on eye diseases, especially in arid and semi-arid areas where increases in air temperatures are expected. Therefore, the main goals of this research are: (i) to highlight the association between common eye diseases and environmental factors; and (ii) to analyze, through the available literature, the health expenditure involved in combating these diseases and the savings from mitigating the environmental factors that aggravate them. Mixed methods were used to assess the cross-variables (environmental factors, eye diseases, health costs). Considering Southern Spain as an example, our results showed that areas with similar climatic conditions could increase eye diseases due to a sustained increase in temperatures and torrential rains, among other factors. We highlight that an increase in eye diseases in Southern Spain is conditioned by the effects of climate change by up to 36.5%; the economic burden of the main eye diseases, extrapolated to the rest of the country, would represent an annual burden of 0.7% of Spain's Gross Domestic Product. In conclusion, the increase in eye diseases has a strong economic and social impact that could be reduced with proper management of the effects of climate change. We propose a new concept: disease sink, defined as any climate change mitigation action which reduces the incidence or morbidity of disease.

Keywords: Southern Spain; climate change; economic impact; environmental factors; ocular diseases.



9. Soneja S, Tsarouchi G, Lumbroso D, Tung DK. A Review of Dengue's Historical and Future Health Risk from a Changing Climate. Curr Environ Health Rep. 2021 Jul 16. doi: 10.1007/s40572-021-00322-8. Epub ahead of print. PMID: 34269994.


Purpose of review: The purpose of this review is to summarize research articles that provide risk estimates for the historical and future impact that climate change has had upon dengue published from 2007 through 2019.

Recent findings: Findings from 30 studies on historical health estimates, with the majority of the studies conducted in Asia, emphasized the importance of temperature, precipitation, and relative humidity, as well as lag effects, when trying to understand how climate change can impact the risk of contracting dengue. Furthermore, 35 studies presented findings on future health risk based upon climate projection scenarios, with a third of them showcasing global level estimates and findings across the articles emphasizing the need to understand risk at a localized level as the impacts from climate change will be experienced inequitably across different geographies in the future. Dengue is one of the most rapidly spreading viral diseases in the world, with ~390 million people infected worldwide annually. Several factors have contributed towards its proliferation, including climate change. Multiple studies have previously been conducted examining the relationship between dengue and climate change, both from a historical and a future risk perspective. We searched the U.S. National Institute of Environmental Health (NIEHS) Climate Change and Health Portal for literature (spanning January 2007 to September 2019) providing historical and future health risk estimates of contracting dengue infection in relation to climate variables worldwide. With an overview of the evidence of the historical and future health risk posed by dengue from climate change across different regions of the world, this review article enables the research and policy community to understand where the knowledge gaps are and what areas need to be addressed in order to implement localized adaptation measures to mitigate the health risks posed by future dengue infection.

Keywords: Climate change; Dengue; Global health; Vector borne disease.



10. Scheelbeek PFD, Dangour AD, Jarmul S, Turner G, Sietsma AJ, Minx JC, Callaghan M, Ajibade I, Austin SE, Biesbroek R, Bowen KJ, Chen T, Davis K, Ensor T, Ford JD, Galappaththi EK, Joe ET, Musah-Surugu IJ, Alverio GN, Schwerdtle PN, Pokharel P, Salubi EA, Scarpa G, Segnon AC, Siña M, Templeman S, Xu J, Zavaleta-Cortijo C, Berrang-Ford L. The effects on public health of climate change adaptation responses: a systematic review of evidence from low- and middle-income countries. Environ Res Lett. 2021 Jul;16(7):073001. doi: 10.1088/1748-9326/ac092c. Epub 2021 Jul 13. PMID: 34267795; PMCID: PMC8276060.



Climate change adaptation responses are being developed and delivered in many parts of the world in the absence of detailed knowledge of their effects on public health. Here we present the results of a systematic review of peer-reviewed literature reporting the effects on health of climate change adaptation responses in low- and middle-income countries (LMICs). The review used the 'Global Adaptation Mapping Initiative' database (comprising 1682 publications related to climate change adaptation responses) that was constructed through systematic literature searches in Scopus, Web of Science and Google Scholar (2013-2020). For this study, further screening was performed to identify studies from LMICs reporting the effects on human health of climate change adaptation responses. Studies were categorised by study design and data were extracted on geographic region, population under investigation, type of adaptation response and reported health effects. The review identified 99 studies (1117 reported outcomes), reporting evidence from 66 LMICs. Only two studies were ex ante formal evaluations of climate change adaptation responses. Papers reported adaptation responses related to flooding, rainfall, drought and extreme heat, predominantly through behaviour change, and infrastructural and technological improvements. Reported (direct and intermediate) health outcomes included reduction in infectious disease incidence, improved access to water/sanitation and improved food security. All-cause mortality was rarely reported, and no papers were identified reporting on maternal and child health. Reported maladaptations were predominantly related to widening of inequalities and unforeseen co-harms. Reporting and publication-bias seems likely with only 3.5% of all 1117 health outcomes reported to be negative. Our review identified some evidence that climate change adaptation responses may have benefits for human health but the overall paucity of evidence is concerning and represents a major missed opportunity for learning. There is an urgent need for greater focus on the funding, design, evaluation and standardised reporting of the effects on health of climate change adaptation responses to enable evidence-based policy action.

Keywords: climate change adaptation; climate change adaptation response; data synthesis; low- and middle-income countries; public health; systematic review.


11. Lin BB, Ossola A, Alberti M, Andersson E, Bai X, Dobbs C, Elmqvist T, Evans KL, Frantzeskaki N, Fuller RA, Gaston KJ, Haase D, Jim CY, Konijnendijk C, Nagendra H, Niemelä J, McPhearson T, Moomaw WR, Parnell S, Pataki D, Ripple WJ, Tan PY. Integrating solutions to adapt cities for climate change. Lancet Planet Health. 2021 Jul;5(7):e479-e486. doi: 10.1016/S2542-5196(21)00135-2. PMID: 34245718.


Record climate extremes are reducing urban liveability, compounding inequality, and threatening infrastructure. Adaptation measures that integrate technological, nature-based, and social solutions can provide multiple co-benefits to address complex socioecological issues in cities while increasing resilience to potential impacts. However, there remain many challenges to developing and implementing integrated solutions. In this Viewpoint, we consider the value of integrating across the three solution sets, the challenges and potential enablers for integrating solution sets, and present examples of challenges and adopted solutions in three cities with different urban contexts and climates (Freiburg, Germany; Durban, South Africa; and Singapore). We conclude with a discussion of research directions and provide a road map to identify the actions that enable successful implementation of integrated climate solutions. We highlight the need for more systematic research that targets enabling environments for integration; achieving integrated solutions in different contexts to avoid maladaptation; simultaneously improving liveability, sustainability, and equality; and replicating via transfer and scale-up of local solutions. Cities in systematically disadvantaged countries (sometimes referred to as the Global South) are central to future urban development and must be prioritised. Helping decision makers and communities understand the potential opportunities associated with integrated solutions for climate change will encourage urgent and deliberate strides towards adapting cities to the dynamic climate reality.



12. Rublee C, Dresser C, Giudice C, Lemery J, Sorensen C. Evidence-Based Heatstroke Management in the Emergency Department. West J Emerg Med. 2021 Feb 26;22(2):186-195. doi: 10.5811/westjem.2020.11.49007. PMID: 33856299; PMCID: PMC7972371.



Introduction: Climate change is causing an increase in the frequency and intensity of extreme heat events, which disproportionately impact the health of vulnerable populations. Heatstroke, the most serious heat-related illness, is a medical emergency that causes multiorgan failure and death without intervention. Rapid recognition and aggressive early treatment are essential to reduce morbidity and mortality. The objective of this study was to evaluate current standards of care for the emergent management of heatstroke and propose an evidence-based algorithm to expedite care.

Methods: We systematically searched PubMed, Embase, and key journals, and reviewed bibliographies. Original research articles, including case studies, were selected if they specifically addressed the recognition and management of heatstroke in any prehospital, emergency department (ED), or intensive care unit population. Reviewers evaluated study quality and abstracted information regarding demographics, scenario, management, and outcome.

Results: In total, 63 articles met full inclusion criteria after full-text review and were included for analysis. Three key themes identified during the qualitative review process included recognition, rapid cooling, and supportive care. Rapid recognition and expedited external or internal cooling methods coupled with multidisciplinary management were associated with improved outcomes. Delays in care are associated with adverse outcomes. We found no current scalable ED alert process to expedite early goal-directed therapies.

Conclusion: Given the increased risk of exposure to heat waves and the time-sensitivity of the condition, EDs and healthcare systems should adopt processes for rapid recognition and management of heatstroke. This study proposes an evidence-based prehospital and ED heat alert pathway to improve early diagnosis and resource mobilization. We also provide an evidence-based treatment pathway to facilitate efficient patient cooling. It is hoped that this protocol will improve care and help healthcare systems adapt to changing environmental conditions.



13. Kalogirou MR, Dahlke S, Davidson S, Yamamoto S. Integrating planetary health into healthcare: A document analysis. Health Policy. 2021 Jun;125(6):799-806. doi: 10.1016/j.healthpol.2021.04.002. Epub 2021 Apr 5. PMID: 33846028.


Background: Anthropogenic climate change poses a major health risk to humankind. The healthcare sector both contributes to climate change and is vulnerable to its impacts. Healthcare's greenhouse gas emissions are primarily derived from its supply chain: the production, transport, and disposal of goods.

Methods: Document analysis was used to investigate the workplace policies of one large, Western Canadian healthcare organization. Policies that indicated how employees should engage with resources were reviewed through the lens of environmentally responsible practice and planetary health. Content and thematic analysis were applied.

Results: Four themes were identified: procurement of resources, resource utilization, resource conservation, and waste management.

Conclusion: There was little evidence of environmental or climate impact consideration within the organization's policies.

Implications: Healthcare organizations could benefit from integrating a planetary health perspective into their policies to deliver healthcare that considers the health and safety of both humans and the climate.

Keywords: Climate change; Healthcare; Planetary health; Policy analysis.



14. Kotcher J, Maibach E, Miller J, Campbell E, Alqodmani L, Maiero M, Wyns A. Views of health professionals on climate change and health: a multinational survey study. Lancet Planet Health. 2021 May;5(5):e316-e323. doi: 10.1016/S2542-5196(21)00053-X. Epub 2021 Apr 8. PMID: 33838130; PMCID: PMC8099728.


Climate change arguably represents one of the greatest global health threats of our time. Health professionals can advocate for global efforts to reduce emissions and protect people from climate change; however, evidence of their willingness to do so remains scarce. In this Viewpoint, we report findings from a large, multinational survey of health professionals (n=4654) that examined their views of climate change as a human health issue. Consistent with previous research, participants in this survey largely understood that climate change is happening and is caused by humans, viewed climate change as an important and growing cause of health harm in their country, and felt a responsibility to educate the public and policymakers about the problem. Despite their high levels of commitment to engaging in education and advocacy on the issue, many survey participants indicated that a range of personal, professional, and societal barriers impede them from doing so, with time constraints being the most widely reported barrier. However, participants say various resources-continuing professional education, communication training, patient education materials, policy statements, action alerts, and guidance on how to make health-care workplaces sustainable-can help to address those barriers. We offer recommendations on how to strengthen and support health professional education and advocacy activities to address the human health challenges of climate change.



15. Dupraz J, Burnand B. Role of Health Professionals Regarding the Impact of Climate Change on Health-An Exploratory Review. Int J Environ Res Public Health. 2021 Mar 20;18(6):3222. doi: 10.3390/ijerph18063222. PMID: 33804669; PMCID: PMC8003659.



Health professionals are increasingly urged to act to protect individuals and populations against the negative effects of climate and environment change on health. However, the amount of evidence supporting initiatives to that end is unknown. We explored the literature examining the awareness, preparedness, and role of healthcare professionals to inform about the impact of climate change on health on the one hand, and literature about the effectiveness of interventions mediated by health professionals aiming at reducing the environmental impact of human activities on the other hand. We included 137 articles published between 2000 and 2020, mostly in general medical and nursing journals. The typical article was a perspective, commentary, or other special article aimed at alerting readers about the impact of climate and environment change on health. We identified 22 studies, of which only two reported interventions. Despite increasing efforts of health professionals to address climate and environment change and related health risks, health literature supporting such efforts remains scarce, and studies assessing the effectiveness of interventions are lacking. We need appropriate evidence to indicate which interventions should be prioritized, considering that the association of health issues with climate and environment change could constitute an effective lever for change.

Keywords: climate change; health professionals; intervention; role.



16. Bikomeye JC, Rublee CS, Beyer KMM. Positive Externalities of Climate Change Mitigation and Adaptation for Human Health: A Review and Conceptual Framework for Public Health Research. Int J Environ Res Public Health. 2021 Mar 3;18(5):2481. doi: 10.3390/ijerph18052481. PMID: 33802347; PMCID: PMC7967605.


Anthropogenic climate change is adversely impacting people and contributing to suffering and increased costs from climate-related diseases and injuries. In responding to this urgent and growing public health crisis, mitigation strategies are in place to reduce future greenhouse gas emissions (GHGE) while adaptation strategies exist to reduce and/or alleviate the adverse effects of climate change by increasing systems' resilience to future impacts. While these strategies have numerous positive benefits on climate change itself, they also often have other positive externalities or health co-benefits. This knowledge can be harnessed to promote and improve global public health, particularly for the most vulnerable populations. Previous conceptual models in mitigation and adaptation studies such as the shared socioeconomic pathways (SSPs) considered health in the thinking, but health outcomes were not their primary intention. Additionally, existing guidance documents such as the World Health Organization (WHO) Guidance for Climate Resilient and Environmentally Sustainable Health Care Facilities is designed primarily for public health professionals or healthcare managers in hospital settings with a primary focus on resilience. However, a detailed cross sectoral and multidisciplinary conceptual framework, which links mitigation and adaptation strategies with health outcomes as a primary end point, has not yet been developed to guide research in this area. In this paper, we briefly summarize the burden of climate change on global public health, describe important mitigation and adaptation strategies, and present key health benefits by giving context specific examples from high, middle, and low-income settings. We then provide a conceptual framework to inform future global public health research and preparedness across sectors and disciplines and outline key stakeholders recommendations in promoting climate resilient systems and advancing health equity.

Keywords: Paris agreement; climate change; conceptual framework; extreme weather events (EWE); global health; green infrastructure; greenhouse gas emissions (GHGE); health co-benefits; health equity; mitigation and adaptation; nationally determined contributions (NDC); positive externalities; public health.


17. Lauriola P, Martín-Olmedo P, Leonardi GS, Bouland C, Verheij R, Dückers MLA, van Tongeren M, Laghi F, van den Hazel P, Gokdemir O, Segredo E, Etzel RA, Abelsohn A, Bianchi F, Romizi R, Miserotti G, Romizi F, Bortolotti P, Vinci E, Giustetto G, Santamaria M, Serafini A, Pegoraro S, Agius R, Zeka A. On the importance of primary and community healthcare in relation to global health and environmental threats: lessons from the COVID-19 crisis. BMJ Glob Health. 2021 Mar;6(3):e004111. doi: 10.1136/bmjgh-2020-004111. PMID: 33692145; PMCID: PMC7948151



In the course of the COVID-19 pandemic, it has become clear that primary healthcare systems play a critical role in clinical care, such as patient screening, triage, physical and psychological support and also in promoting good community advice and awareness in coordination with secondary healthcare and preventive care. Because of the role of social and environmental factors in COVID-19 transmission and burden of disease, it is essential to ensure that there is adequate coordination of population-based health services and public health interventions. The COVID-19 pandemic has shown the primary and community healthcare (P&CHC) system's weaknesses worldwide. In many instances, P&CHC played only a minor role, the emphasis being on hospital and intensive care beds. This was compounded by political failures, in supporting local community resilience. Placing community building, social cohesion and resilience at the forefront of dealing with the COVID-19 crisis can help align solutions that provide a vision of 'planetary health'. This can be achieved by involving local well-being and participation in the face of any pervasive health and environmental crisis, including other epidemics and large-scale ecological crises. This paper proposes that P&CHC should take on two critical roles: first, to support local problem-solving efforts and to serve as a partner in innovative approaches to safeguarding community well-being; and second, to understand the local environment and health risks in the context of the global health perspective. We see this as an opportunity of immediate value and broad consequence beyond the control of the COVID-19 pandemic.

Box 1

Primary and community healthcare role in relation to global health threats

  • Public education and raising awareness.
  • Day-by-day involvement in local/regional/national strategies to tackle antimicrobial resistance within a One Health approach.
  • Early alert systems: impending weather extremes, infectious disease outbreaks.
  • Disaster preparedness, including increasing the health system’s ‘surge’ capacity to respond to emergencies.
  • Enhanced infectious disease control programmes.
    • Food safety, vaccine programmes, case detection and treatment.
  • Improved surveillance.
    • Vector control.
    • Risk indicators (eg, aeroallergen concentration).
    • Health outcomes (eg, infectious disease outbreaks, rural suicides, seasonal asthma peaks).
  • Appropriate health workforce training, including continuing professional development (eg, updated understanding of climatic influences on health, training in public health).

(Adapted from Blashki et al [40]).

Blashki G, Abelsohn A, Woollard R, et al. . General Practitioners' responses to global climate change - lessons from clinical experience and the clinical method. Asia Pac Fam Med 2012;11:6. 10.1186/1447-056X-11-6 - DOI PMC PubMed


18. Erens B, Williams L, Exley J, Ettelt S, Manacorda T, Hajat S, Mays N. Public attitudes to, and behaviours taken during, hot weather by vulnerable groups: results from a national survey in England. BMC Public Health. 2021 Sep 6;21(1):1631. doi: 10.1186/s12889-021-11668-x. PMID: 34488695; PMCID: PMC8422617.


Background: Hot weather leads to increased illness and deaths. The Heatwave Plan for England (HWP) aims to protect the population by raising awareness of the dangers of hot weather, especially for those most vulnerable. Individuals at increased risk to the effects of heat include older adults, particularly 75+, and those with specific chronic conditions, such as diabetes, respiratory and heart conditions. The HWP recommends specific protective actions which relate to five heat-health alert levels (levels 0-4). This study examines the attitudes to hot weather of adults in England, and the protective measures taken during a heatwave.

Methods: As part of a wider evaluation of the implementation and effects of the HWP, a survey (n = 3153) and focus groups, a form of group interview facilitated by a researcher, were carried out after the June 2017 level 3 heat-health alert. Survey respondents were categorised into three groups based on their age and health status: 'vulnerable' (aged 75+), 'potentially vulnerable' (aged 18-74 in poor health) and 'not vulnerable' (rest of the adult population) to hot weather. Multivariable logistic regression models identified factors associated with these groups taking protective measures. In-person group discussion, focused on heat-health, were carried out with 25 people, mostly aged 75 + .

Results: Most vulnerable and potentially vulnerable adults do not consider themselves at risk of hot weather and are unaware of the effectiveness of important protective behaviours. Only one-quarter of (potentially) vulnerable adults reported changing their behaviour as a result of hearing hot weather-related health advice during the level 3 alert period. Focus group findings showed many vulnerable adults were more concerned about the effects of the sun's ultra-violet radiation on the skin than on the effects of hot temperatures on health.

Conclusions: Current public health messages appear to be insufficient, given the low level of (potentially) vulnerable adults changing their behaviour during hot weather. In the context of increasingly warmer summers in England due to climate change, public health messaging needs to convince (potentially) vulnerable adults of all the risks of hot weather (not just effects of sunlight on the skin) and of the importance of heat protective measures.

Keywords: Emergency planning; Heat; Hot weather; Older people.


19. Kidd SA, Hajat S, Bezgrebelna M, McKenzie K; Climate-Homelessness Working Group. The climate change-homelessness nexus. Lancet. 2021 May 8;397(10286):1693-1694. doi: 10.1016/S0140-6736(21)00834-5. Epub 2021 Apr 12. PMID: 33857438.

Climate change affects human health and wellbeing1 with differential impacts on populations and regions. For example, climate change disproportionally affects girls and women and can amplify conflict and violence in resource-deprived environments.2 The way climate change exacerbates economic and social disparities underscores the role of migration in response to climate pressures.3 Movement or staying in place, whether forced or voluntary, have important immediate and downstream implications for the growing numbers of people affected. Although the mechanisms through which climate impacts human health are becoming better understood, substantial knowledge gaps remain. One such gap is the role of shelter. Housing and shelter are pivotal in considering the physical and mental health impacts of climate change for individuals without shelter or who live in temporary and unfit housing.4

For homeless and marginally housed people, the risks related to climate change fall in two domains.5 First, marginally housed individuals are at risk of becoming homeless due to climate-change-related factors, including rising sea levels, extreme weather events, and economic strain due to energy, water, and food insecurity. Second, individuals who do not have shelter are exposed to an array of climate-related risks, including air pollution, extreme heat and cold, and foodborne, waterborne, and vectorborne diseases. The risks related to exposures are compounded by the compromised health of homeless populations, their inadequate access to health and social care services, and their limited inclusion in climate risk mitigation and disaster response strategies.6 By contrast with a much larger literature on climate-driven migration, the literature that addresses how shelter influences health outcomes is minimal, with the least information available for the places most affected by climate change.5



20.  Murage P, Kovats S, Sarran C, Taylor J, McInnes R, Hajat S. What individual and neighbourhood-level factors increase the risk of heat-related mortality? A case-crossover study of over 185,000 deaths in London using high-resolution climate datasets. Environ Int. 2020 Jan;134:105292. doi: 10.1016/j.envint.2019.105292. Epub 2019 Nov 11. PMID: 31726356; PMCID: PMC7103759.


Objective: Management of the natural and built environments can help reduce the health impacts of climate change. This is particularly relevant in large cities where urban heat island makes cities warmer than the surrounding areas. We investigate how urban vegetation, housing characteristics and socio-economic factors modify the association between heat exposure and mortality in a large urban area.

Methods: We linked 185,397 death records from the Greater London area during May-Sept 2007-2016 to a high resolution daily temperature dataset. We then applied conditional logistic regression within a case-crossover design to estimate the odds of death from heat exposure by individual (age, sex) and local area factors: land-use type, natural environment (vegetation index, tree cover, domestic garden), built environment (indoor temperature, housing type, lone occupancy) and socio-economic factors (deprivation, English language, level of employment and prevalence of ill-health).

Results: Temperatures were higher in neighbourhoods with lower levels of urban vegetation and with higher levels of income deprivation, social-rented housing, and non-native English speakers. Heat-related mortality increased with temperature increase (Odds Ratio (OR), 95% CI = 1.039, 1.036-1.043 per 1 °C temperature increase). Vegetation cover showed the greatest modification effect, for example the odds of heat-related mortality in quartiles with the highest and lowest tree cover were OR, 95%CI 1.033, 1.026-1.039 and 1.043, 1.037-1.050 respectively. None of the socio-economic variables were a significant modifier of heat-related mortality.

Conclusions: We demonstrate that urban vegetation can modify the mortality risk associated with heat exposure. These findings make an important contribution towards informing city-level climate change adaptation and mitigation policies.


21. Berrang-Ford L, Sietsma AJ, Callaghan M, Minx JC, Scheelbeek PFD, Haddaway NR, Haines A, Dangour AD. Systematic mapping of global research on climate and health: a machine learning review. Lancet Planet Health. 2021 Aug;5(8):e514-e525. doi: 10.1016/S2542-5196(21)00179-0. Epub 2021 Jul 14. PMID: 34270917; PMCID: PMC8358978.


Background: The global literature on the links between climate change and human health is large, increasing exponentially, and it is no longer feasible to collate and synthesise using traditional systematic evidence mapping approaches. We aimed to use machine learning methods to systematically synthesise an evidence base on climate change and human health.

Methods: We used supervised machine learning and other natural language processing methods (topic modelling and geoparsing) to systematically identify and map the scientific literature on climate change and health published between Jan 1, 2013, and April 9, 2020. Only literature indexed in English were included. We searched Web of Science Core Collection, Scopus, and PubMed using title, abstract, and keywords only. We searched for papers including both a health component and an explicit mention of either climate change, climate variability, or climate change-relevant weather phenomena. We classified relevant publications according to the fields of climate research, climate drivers, health impact, date, and geography. We used supervised and unsupervised machine learning to identify and classify relevant articles in the field of climate and health, with outputs including evidence heat maps, geographical maps, and narrative synthesis of trends in climate health-related publications. We included empirical literature of any study design that reported on health pathways associated with climate impacts, mitigation, or adaptation.

Findings: We predict that there are 15 963 studies in the field of climate and health published between 2013 and 2019. Climate health literature is dominated by impact studies, with mitigation and adaptation responses and their co-benefits and co-risks remaining niche topics. Air quality and heat stress are the most frequently studied exposures, with all-cause mortality and infectious disease incidence being the most frequently studied health outcomes. Seasonality, extreme weather events, heat, and weather variability are the most frequently studied climate-related hazards. We found major gaps in evidence on climate health research for mental health, undernutrition, and maternal and child health. Geographically, the evidence base is dominated by studies from high-income countries and China, with scant evidence from low-income counties, which often suffer most from the health consequences of climate change.

Interpretation: Our findings show the importance and feasibility of using automated machine learning to comprehensively map the science on climate change and human health in the age of big literature. These can provide key inputs into global climate and health assessments. The scant evidence on climate change response options is concerning and could significantly hamper the design of evidence-based pathways to reduce the effects on health of climate change. In the post-2015 Paris Agreement era of climate solutions, we believe much more attention should be given to climate adaptation and mitigation options and their effects on human health.


22. Vicedo-Cabrera AM, Scovronick N, Sera F, Royé D, Schneider R, Tobias A, Astrom C, Guo Y, Honda Y, Hondula DM, Abrutzky R, Tong S, de Sousa Zanotti Stagliorio Coelho M, Saldiva PHN, Lavigne E, Correa PM, Ortega NV, Kan H, Osorio S, Kyselý J, Urban A, Orru H, Indermitte E, Jaakkola JJK, Ryti N, Pascal M, Schneider A, Katsouyanni K, Samoli E, Mayvaneh F, Entezari A, Goodman P, Zeka A, Michelozzi P, de'Donato F, Hashizume M, Alahmad B, Diaz MH, De La Cruz Valencia C, Overcenco A, Houthuijs D, Ameling C, Rao S, Ruscio FD, Carrasco-Escobar G, Seposo X, Silva S, Madureira J, Holobaca IH, Fratianni S, Acquaotta F, Kim H, Lee W, Iniguez C, Forsberg B, Ragettli MS, Guo YLL, Chen BY, Li S, Armstrong B, Aleman A, Zanobetti A, Schwartz J, Dang TN, Dung DV, Gillett N, Haines A, Mengel M, Huber V, Gasparrini A. The burden of heat-related mortality attributable to recent human-induced climate change. Nat Clim Chang. 2021 Jun;11(6):492-500. doi: 10.1038/s41558-021-01058-x. Epub 2021 May 31. PMID: 34221128; PMCID: PMC7611104.


Climate change affects human health; however, there have been no large-scale, systematic efforts to quantify the heat-related human health impacts that have already occurred due to climate change. Here, we use empirical data from 732 locations in 43 countries to estimate the mortality burdens associated with the additional heat exposure that has resulted from recent human-induced warming, during the period 1991-2018. Across all study countries, we find that 37.0% (range 20.5-76.3%) of warm-season heat-related deaths can be attributed to anthropogenic climate change and that increased mortality is evident on every continent. Burdens varied geographically but were of the order of dozens to hundreds of deaths per year in many locations. Our findings support the urgent need for more ambitious mitigation and adaptation strategies to minimize the public health impacts of climate change.


23. Foong LH, Huntley R. Communicating about climate change - Who is listening, who isn't and why: Implications for medical professionals. J Paediatr Child Health. 2021 Sep 21. doi: 10.1111/jpc.15717. Epub ahead of print. PMID: 34549847.


Community concern about climate change in the community in general is strong and getting stronger but greater action on climate change is contingent upon whether the public sees strong links between climate effects and personal and community wellbeing in the present as well as the future. Medical and health-care professions can be effective messengers about the impacts of climate given their trusted status and ability to draw connections between climate change and physical and mental health.

Keywords: climate change and health; climate change communication; climate change impact.


24. Jay O, Capon A, Berry P, Broderick C, de Dear R, Havenith G, Honda Y, Kovats RS, Ma W, Malik A, Morris NB, Nybo L, Seneviratne SI, Vanos J, Ebi KL. Reducing the health effects of hot weather and heat extremes: from personal cooling strategies to green cities. Lancet. 2021 Aug 21;398(10301):709-724. doi: 10.1016/S0140-6736(21)01209-5. PMID: 34419206.


Heat extremes (ie, heatwaves) already have a serious impact on human health, with ageing, poverty, and chronic illnesses as aggravating factors. As the global community seeks to contend with even hotter weather in the future as a consequence of global climate change, there is a pressing need to better understand the most effective prevention and response measures that can be implemented, particularly in low-resource settings. In this Series paper, we describe how a future reliance on air conditioning is unsustainable and further marginalises the communities most vulnerable to the heat. We then show that a more holistic understanding of the thermal environment at the landscape and urban, building, and individual scales supports the identification of numerous sustainable opportunities to keep people cooler. We summarise the benefits (eg, effectiveness) and limitations of each identified cooling strategy, and recommend optimal interventions for settings such as aged care homes, slums, workplaces, mass gatherings, refugee camps, and playing sport. The integration of this information into well communicated heat action plans with robust surveillance and monitoring is essential for reducing the adverse health consequences of current and future extreme heat.


25. Wyns A, van Daalen KR. From pandemic to Paris: the inclusion of COVID-19 response in national climate commitments. Lancet Planet Health. 2021 May;5(5):e256-e258. doi: 10.1016/S2542-5196(21)00111-X. Epub 2021 Apr 21. PMID: 33894135; PMCID: PMC8099730.


26. Wabnitz KJ, Gabrysch S, Guinto R, Haines A, Herrmann M, Howard C, Potter T, Prescott SL, Redvers N. A pledge for planetary health to unite health professionals in the Anthropocene. Lancet. 2020 Nov 7;396(10261):1471-1473. doi: 10.1016/S0140-6736(20)32039-0. Epub 2020 Sep 30. PMID: 33010210; PMCID: PMC7527204.


27. Ryan EC, Dubrow R, Sherman JD. Medical, nursing, and physician assistant student knowledge and attitudes toward climate change, pollution, and resource conservation in health care. BMC Med Educ. 2020 Jun 23;20(1):200. doi: 10.1186/s12909-020-02099-0. PMID: 32576175; PMCID: PMC7310528.



Background: Climate change and pollution generated by the health care sector impose significant public health burdens. This study aimed to assess medical, nursing and physician assistant student knowledge and attitudes regarding climate change, pollution from the health care sector, and responsibility for resource conservation within professional practice.

Methods: In February-March, 2018, medical, nursing, and physician assistant students at Yale University (1011 potential respondents) were sent a 17-question online Qualtrics survey. Data analysis included descriptive statistics, as well as Fisher's exact test and logistic regression to assess associations between variables of interest and the personal characteristics of gender, age, geographic place of origin, school, and year in school (among medical students).

Results: The response rate was 28% (280 respondents). 90% felt that physicians, nurses, and physician assistants have a responsibility to conserve resources and prevent pollution within their professional practice. 63% agreed or strongly agreed that the relationship between pollution, climate change, and health should be covered in the classroom and should be reinforced in the clinical setting. 57% preferred or strongly preferred reusable devices. 91% felt lack of time and production pressure, and 85% believed that lack of education on disease burden stemming from health care pollution, were barriers to taking responsibility for resource conservation and pollution prevention. Women and physician assistant students exhibited a greater commitment than men and medical students, respectively, to address pollution, climate change, and resource conservation in patient care and professional practice.

Conclusion: We found that health professional students are engaged with the concept of environmental stewardship in clinical practice and would like to see pollution, climate change, and health covered in their curriculum. In order for this education to be most impactful, more research and industry transparency regarding the environmental footprint of health care materials and specific clinician resource consumption patterns will be required.

Keywords: Climate change; Health care system; Medical student; Nursing student; Physician assistant student; Pollution; Pollution prevention; Resource conservation.


28. Lee HR, Pagano I, Borth A, Campbell E, Hubbert B, Kotcher J, Maibach E. Health professional's willingness to advocate for strengthening global commitments to the Paris climate agreement: Findings from a multi-nation survey. J Clim Chang Health. 2021 May;2:None. doi: 10.1016/j.joclim.2021.100016. PMID: 34278375; PMCID: PMC8262252.


Health professionals have the potential to address the health threats posed by climate change in many ways. This study sought to understand the factors that influence health professionals' willingness to engage in climate advocacy. We hypothesized and tested a model with six antecedent factors predicting willingness to engage in advocacy for strengthening global commitments to the Paris Agreement. Using survey data from members of health professional associations in 12 nations (n = 3,977), we tested the hypothesized relationships with structural equation modeling. All of the hypothesized relationships were confirmed. Specifically, higher rates of perceived expert consensus about human-caused climate change predicted greater climate change belief certainty and belief in human causation. In turn, all three of these factors, including higher levels of perceived health harms from climate change, positively predicted affective involvement with the issue. Affective involvement positively predicted the feeling that health professionals have a responsibility to deal with climate change. Lastly, this sense that climate advocacy is a responsibility of health professionals strongly predicted willingness to advocate. As a unique study of predictors of health professionals' willingness to advocate for climate change, our findings provide unique insight into how an influential set of trusted voices might be activated to address what is arguably the world's most pressing public health threat. Limitations of the study and suggestions for future research are presented, and implications for message development are discussed.

Keywords: Climate advocacy; Climate change; Health communication; Health professionals; Paris agreement.


29. Green S, Sakuls P, Levitt S. Cycling for health: Improving health and mitigating the climate crisis. Can Fam Physician. 2021 Oct;67(10):739-742. doi: 10.46747/cfp.6710739. PMID: 34649896; PMCID: PMC8516176.


Objective: To review the literature about cycling and health, and to provide an overview and discussion of the available evidence.

Sources of information: The MeSH terms bicycle and transportation were searched in PubMed. Clinical trials, practice reviews, and systematic reviews were included. All reference lists were reviewed for additional articles.

Main message: Climate change is a threat to health. In Canada alone, transportation is the second largest source of greenhouse gas emissions. Active transportation, which is any form of human-powered transportation, can mitigate the health effects of the climate crisis while simultaneously improving the health of people. Physical activity improves overall well-being, as well as physical and mental health. Active transportation, particularly cycling, is a convenient way to meet physical activity targets, reduce risk of disease and all-cause mortality, and derive mental health and social benefits. Family physician advocacy for active transportation has been shown to increase cycling levels in patients compared with no physician advocacy.

Conclusion: Family physicians can help to increase the level of active transportation at the individual patient level through patient education and behaviour change counseling; at the community level through community education and political advocacy; and at the policy level through partnerships with larger organizations.


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